Childhood tuberculosis with rare dual involvement: Skin and central nervous system affected in two distinct cases

Tuberculosis (TB) remains a major public health concern in developing countries. The World Health Organization (WHO) reported 10.8 million new cases globally in 2023 – nearly half from South-East Asia. While pulmonary TB is most common, extrapulmonary TB, particularly central nervous system tuberculosis (CNS-TB) and cutaneous TB, presents diagnostic challenges and high morbidity. We report two pediatric cases of disseminated TB initially presenting with dermatologic manifestations and later neurological involvement. Case-1 involved a 12-year-old girl with chronic skin lesions misdiagnosed as bacterial infections, who later developed CNS symptoms. Investigations confirmed Mycobacterium tuberculosis with CNS-TB and scrofuloderma. Second case, a 10-year-old malnourished girl, presented with back pain, progressive lower limb weakness, and papular skin lesions. Magnetic resonance imaging revealed Pott’s spine, and biopsy confirmed Lichen Scrofulosorum – a tuberculid reaction to mycobacterial antigens. These cases highlight that early cutaneous signs may precede systemic involvement. Clinicians in endemic regions should maintain a high index of suspicion for TB in children with chronic skin lesions, to ensure timely diagnosis, and prevent neurological sequelae.