A case of necrotizing fasciitis secondary to cutaneous tuberculosis in a patient with systemic lupus erythematosus (SLE).

Introduction and importance: Skin tuberculosis is a rare chronic skin disease caused by Mycobacterium tuberculosis. Due to variations in host immunity, as well as differences in the toxicity, quantity, and routes of invasion of Mycobacterium tuberculosis, different clinical manifestations can occur. Case presentation: A 60-year-old female with a history of SLE for 16 years presented with dark brown nodules and plaques on the left lower limb and dorsal hands for approximately 8 months, which worsened with erythema and ulceration over the last 3 months. Prior to this, she was diagnosed with Mycobacterium tuberculosis infection. Her ulcer progressively increased in size and number, accompanied by yellowish-white cheesy discharge. Diagnostic evaluations, including a biopsy, confirmed the diagnosis of NF. Subsequently, the patient underwent treatment with a combination of surgical intervention, pharmacotherapy, and other supportive measures, leading to improvement and eventual discharge. Clinical discussion: Unlike the classical presentations, this case report describes a rare manifestation of NF secondary to cutaneous tuberculosis complicated by SLE. This presentation poses challenges in diagnosis and treatment, emphasizing the significance of comprehensive debridement and combination therapy in such patients. Further research is necessary to validate its effectiveness across broader patient demographics, especially in pediatrics and pregnant women. Conclusion: This case highlights the rare association between NF and cutaneous tuberculosis. The report of this case, with its rare clinical manifestations, can serve as a good reference to reduce misdiagnosis of cutaneous tuberculosis and provide timely and effective treatment for patients.