Long-standing, multifocal Tuberculosis verrucosa cutis: undiagnosed for 40 years.

Tuberculosis (TB) is a chronic infectious disease primarily affecting the lungs, with extrapulmonary TB comprising 20% of cases. Among these, cutaneous TB (CTB) accounts for 1-2%, often overlooked due to its rarity and varied presentations. This report highlights an unusual case of Tuberculosis verrucosa cutis (TVC) A 60-year-old male, presented with non-healing skin lesion that remained undiagnosed for 40 years. The lesion, which involved multiple areas of the body, exhibited large annular plaques with indurated edges and atrophic scars. Diagnosis was made through a detailed clinical history and examination, confirmed by fine-needle aspiration cytology (FNAC), which revealed necrotizing granulomatous inflammation. The patient responded well to anti-TB treatment, showing significant improvement within two months. This case underscores the importance of clinical suspicion in diagnosing CTB, particularly in endemic regions, and suggests that FNAC is a valuable diagnostic tool in resource-limited settings. • This report highlights Tuberculosis verrucosa cutis (TVC) that remained undiagnosed for 40 years. • TVC is exogenous form of cutaneous tuberculosis (CTB). • CTB may go undiagnosed for several years due to its rarity and diverse presentation. • FNAC might be helpful in diagnosing CTB, especially in resource limited setups.