Primary nasal tuberculosis (TB) is a rare form of extrapulmonary TB, particularly in patients receiving anti-tumor necrosis factor (TNF) immunotherapy. As a result, its diagnosis remains challenging.

A 58-year-old male patient presented to the ear, nose, and throat department with right-sided nasal obstruction and bloody discharge for 1 month. He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation. Biopsy findings revealed chronic granulomatous inflammation and a few acid-fast bacilli, suggestive of primary nasal TB. He was referred to our TB management department for treatment with oral anti-TB agents. After 9 months, the nasal lesions had disappeared. No recurrence was noted during follow-up.

The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate, particularly when pathological findings suggest granulomatous inflammation.

Although cutaneous tuberculosis (TB) is a rare form of extra-pulmonary TB, lupus vulgaris is the commonest variant of cutaneous TB. We present a 14 year female with non-healing ulcer over the upper lip extending and destroying the collumela and part of anterior nasal septum. Histopathological examination revealed TB as a possible cause of the lesion. Identification of acid-fast bacilli on direct stained smears confirms the diagnosis of TB. Complete healing of the ulcer was achieved with anti-tuberculous regime leaving a residual fibrosis over the site of the ulcer.