Clinical Spectrum and Diagnostic Challenges of Atypical Cutaneous Tuberculosis: A Global Case Series Analysis

Cutaneous tuberculosis (CTB) is a rare form of extrapulmonary tuberculosis, accounting for less than 2% of all TB cases. Its atypical presentations, which deviate from the classical forms like lupus vulgaris and tuberculosis verrucosa cutis, pose significant diagnostic challenges. These atypical forms often mimic other dermatological conditions, leading to misdiagnosis and delayed treatment. This review examines atypical CTB cases reported globally from 2018 to 2024, focusing on lesion morphology, diagnostic strategies, treatment approaches, and clinical outcomes. A total of 20 cases from 8 studies were analysed, with findings showing that verrucous CTB (30%) and ulcerative forms (20%) were the most common morphological subtypes. Misdiagnosis occurred in 70% of the cases, with histopathology being the most reliable diagnostic tool. Immunocompromised patients, including those with HIV, diabetes, and post-transplant states, were more likely to present with severe and atypical forms. Anti-tubercular therapy (ATT) was effective in most cases, with 90% of patients achieving complete resolution. This review highlights the need for heightened clinical suspicion, early biopsy, and the use of advanced diagnostic tools such as PCR and imaging, especially in high-risk populations. The study emphasises the importance of timely diagnosis and treatment to prevent morbidity and improve patient outcomes in atypical CTB. How to cite this article:Agila A, Palaniappan D, Manickam N, Vellaisamy S G, Gopalan K. Clinical Spectrum and Diagnostic Challenges of Atypical Cutaneous Tuberculosis: A Global Case Series Analysis. J Commun Dis. 2025;57(3):157-165. DOI: https://doi.org/10.24321/0019.5138.202582