Hidden granuloma in plain sight: primary multimucosal tuberculosis

Primary mucosal tuberculosis is an exceptionally rare extrapulmonary manifestation, representing a diagnostic challenge due to its marked anatomo-clinical polymorphism and paucity of systemic signs. We report a 62-year-old immunocompetent woman with multifocal mucosal facial plaques showing a fluctuating course. Dermoscopy demonstrated a lupoid pattern. Radiologic evaluation revealed sinonasal extension with osseous lysis. Histopathology confirmed confluent Koester follicles with central caseous necrosis. Systemic evaluation showed no pulmonary or visceral involvement, with only a positive tuberculin skin test supporting prior sensitization. Prompt recognition enabled timely antituberculous therapy, preventing further structural and functional sequelae.