The Great Imitator of the Groin: Scrofuloderma Mimicking Hidradenitis Suppurativa - A Diagnostic Challenge

Background: Scrofuloderma is a form of cutaneous tuberculosis caused by direct extension from underlying tuberculous lymphadenitis. Inguinal involvement is uncommon and may mimic Hidradenitis suppurativa, leading to diagnostic delay. Objective: To describe a case of inguinal scrofuloderma clinically masquerading as hidradenitis suppurativa and highlight distinguishing features. Methodology: A detailed clinical evaluation, laboratory investigations, imaging, microbiological testing, and histopathological examination were performed. Results: A 24-year-old Female presented with chronic recurrent discharging sinuses in the right inguinal region for 8 months. Initially treated as hidradenitis suppurativa, further evaluation revealed acid-fast bacilli on Ziehl?Neelsen staining and caseating granulomas on biopsy. CBNAAT confirmed Mycobacterium tuberculosis. The patient responded dramatically to standard antitubercular therapy. Conclusion: Scrofuloderma should be considered in chronic groin sinuses, especially in tuberculosis-endemic regions. Early biopsy and microbiological confirmation prevent misdiagnosis and inappropriate immunosuppressive therapy.