Tuberculosis of bilateral axillary lymph nodes mimicking hidradenitis suppurativa

Background: Hidradenitis Suppurativa (HS) is a chronic inflammatory disorder primarily affecting the apocrine gland-bearing regions, notably the axillary, inguinal, and anogenital areas. Its clinical presentation involves painful inflammatory lesions that can mimic other conditions. Axillary tuberculosis (TB) is rare, affecting approximately 3% of tuberculous lymphadenitis cases. Case Presentation: We describe a case of a 32-year-old male presenting with bilateral axillary swellings and discharging sinuses, clinically suggestive of HS. Despite the clinical suspicion, cytological examination confirmed tuberculosis of the lymph nodes, rather than HS. The patient had no prior TB history but was a daily hookah smoker. Discussion: The presentation of isolated axillary TB without evident systemic TB signs complicates diagnosis, especially when clinical features overlap with HS. Our patient's clinical and radiological findings initially leaned towards HS. However, cytology confirmed TB, highlighting the diagnostic challenge. Differentiating between these conditions is crucial given their distinct treatment approaches and prognosis. Conclusion: Bilateral axillary TB misdiagnosed as HS is uncommon but essential to consider, especially in TB-endemic regions like India. Clinicians must maintain a high index of suspicion for TB to ensure timely diagnosis and appropriate management, avoiding potential complications.