Erythema nodosum as a rare presentation of pulmonary tuberculosis in adolescents: A case report

Aim and background Tuberculosis (TB), caused by the Mycobacterium tuberculosis complex, is a multisystemic infectious disease with variable clinical manifestations. Pulmonary involvement is the most common presentation, whereas cutaneous manifestations are rare. Early diagnosis and timely treatment are essential to prevent organ damage, reduce long-term sequelae, and minimize psychosocial impact, particularly in children and adolescents. This case highlights the importance of maintaining a high index of suspicion for TB, even in atypical presentations such as dermatologic findings, especially in high-endemicity settings. Case description We report the case of an 11-year-old female with confirmed active pulmonary TB who presented with tender nodular lesions on the lower limbs. The diagnosis was established based on clinical, microbiological, immunological, and radiological criteria. Conclusion A comprehensive clinical approach—integrating detailed history-taking, targeted diagnostic workup, and multidisciplinary evaluation—is key to ensuring treatment success and reducing complications in high-burden diseases like tuberculosis Clinical significance Erythema nodosum is a rare initial manifestation of TB in children and adolescents, with limited cases reported in the literature.