Cutaneous Tuberculosis With Multisystem Involvement in an Immunocompetent Refugee

Cutaneous tuberculosis (CTB) is an uncommon skin infection that can mimic other dermatologic conditions and delay recognition. Herein, we present a case of TB chancre, a form of CTB caused by exogenous inoculation. A 19-year-old immunocompetent male refugee from Sudan presented with a five-month history of non-healing wounds on his right shoulder and three weeks of bilateral lower extremity weakness. Diagnostic examination revealed the presence of a spinal epidural abscess and lung consolidation, with culture of the spinal abscess positive for Mycobacterium tuberculosis (MTB). Skin biopsy of the shoulder lesion revealed granulomatous dermatitis, with subsequent culture confirming MTB from the cutaneous wound at approximately six weeks and from sputum at eight weeks. During admission, the patient was treated with standard RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) therapy, resulting in improvement of wound healing and stabilization of neurologic symptoms. This case emphasizes the diagnostic challenges of CTB due to its atypical and non-specific presentation and highlights the importance of considering CTB in the differential diagnosis for chronic, non-healing wounds in patients from endemic areas or with relevant exposure history.