Lesson Learnt of the Management of Bizarre Scrofuloderma Evolving to the Chest Wall in Male Adolescents: A Rare Case Report

Background: Cutaneous tuberculosis is a rare manifestation of extrapulmonary tuberculosis in children. Scrofuloderma is the most common form of cutaneous tuberculosis in the developing countries. It typically results from the secondary spread of infection in the lymph node that invade the skin. We report a remarkable case of scrofuloderma evolving to chest wall in an adolescent male. Case Presentation: A 16-year-old adolescent male presented to the Pediatric Respirology Clinic at Hasan Sadikin Hospital with a new lump on the right side of his neck. He had a prior history of bilateral cervical lumps and a mass on the right chest wall. The patient had previously received antituberculosis therapy at inadequate dosages. Fine-needle aspiration biopsy of the cervical lumps confirmed tuberculous lymphadenitis. A thoracic CT scan revealed an abscess, and thoracotomy with aspiration was performed. Histopathological examination confirmed tuberculous inflammation of the chest wall. He was restarted on adult fixed-dose combination anti-tuberculosis therapy at an adequate dose and continued treatment for 12 months. As a result, the lumps resolved, skin lesions healed, and significant weight gain occured. Conclusion: In high TB-burden settings, clinicians must be equipped to recognize the diverse manifestations of lymph node tuberculosis. Scrofuloderma can extend beyond the cervical region to involve the chest wall. Early diagnosis through histopathological examination and molecular testing, along with a combination of surgical intervention and appropriate anti-tuberculosis therapy, is crucial. In adolescents, multidisciplinary management and close monitoring are key to achieving favorable outcomes and preventing recurrence.