Cutaneous Tuberculosis Presenting as Rhino-Facial Nodular Swelling

Cutaneous tuberculosis is an uncommon manifestation of Mycobacterium tuberculosis infection and may present diverse and atypical clinical features, often resulting in diagnostic delay. The case of a 72-year-old woman who presented with a gradually progressive nodular swelling on the left side of her nose, associated with epiphora, is reported in the present study. A clinical examination revealed a firm rhino-facial nodular lesion with ipsilateral nasolacrimal duct obstruction. Initial investigations were inconclusive, and the Mantoux test result was negative. Repeat histopathology revealed epithelioid granulomas with multinucleated giant cells consistent with granulomatous dermatitis. A cutaneous tuberculosis-specific assay result was positive, in conjunction with clinicopathological findings, which supported the diagnosis of an atypical nodular type of lupus vulgaris. The patient showed marked clinical improvement after the initiation of standard antitubercular therapy. This case highlights the diagnostic challenges posed by atypical facial lupus vulgaris and underscores the importance of clinicopathological correlation, with adjunctive use of immunological assays when conventional investigations are inconclusive, particularly in tuberculosis-endemic regions.