Background: Tuberculosis (TB) remains a significant health issue globally, particularly in developing countries. Cutaneous tuberculosis is uncommon and accounts for only 1-2% of extrapulmonary cases. Tuberculosis verrucosa cutis (TBVC) is the most common form of exogenous cutaneous TB, which occurs in previously sensitized individuals by direct inoculation of mycobacteria. Multifocal TBVC is extremely rare and is a diagnostic challenge itself. To the best of our knowledge, only four cases of multifocal TBVC involving anatomically distant sites have been reported in immunocompetent individuals.

Case Report: We report a case of multifocal TBVC in a 29-year-old healthy male armed forces personnel. Initially misdiagnosed as verruca vulgaris, he presented to our center with recurrence in the form of multiple warty lesions on the left ankle, right ear, and back. Histopathological examination revealed granulomatous inflammation, consistent with TBVC. Despite negative Ziehl-Neelsen staining and PCR for Mycobacterium tuberculosis, a positive Interferon Gamma Release Assay (IGRA) supported the diagnosis.

Conclusions: This case highlights the complexities of diagnosing multifocal TBVC, particularly in immunocompetent individuals. The lesions showed a significant response within three months of starting anti-tubercular therapy, underscoring the necessity for a high index of suspicion and the critical role of histopathology. Multifocal cutaneous TB is rare, and this article emphasizes the importance of awareness among clinicians to avoid misdiagnosis.