Penile ulcers unmasking disseminated tubercular lymphadenitis in a patient with idiopathic interstitial lung disease

We report a rare case of penile papulonecrotic tuberculid (PNT) in a middle-aged male with idiopathic interstitial lung disease (ILD) on chronic steroids, presenting with recurrent, painless genital ulcers. Systemic evaluation revealed disseminated tubercular lymphadenitis as the primary focus. The patient was diagnosed with PNT based on clinical and histopathological findings, and tuberculosis was confirmed through imaging and cytology. This case highlights the diagnostic challenge of penile PNT, particularly in immunosuppressed individuals, and underscores the importance of comprehensive tuberculosis screening in patients with tuberculids, especially those with underlying chronic conditions like ILD.