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Cutaneous tuberculosis (TB) is a rare extrapulmonary manifestation that often presents atypically, particularly in patients with comorbid conditions like diabetes mellitus. Such presentations frequently lead to diagnostic delays and prolonged morbidity.We report the case of a woman in her late 40s with type 2 diabetes who presented with a chronic, progressively enlarging facial plaque and systemic constitutional symptoms. While radiological findings were highly suggestive of pulmonary TB, repeated sputum testing was inconclusive. Diagnostic confirmation was achieved through tissue-based molecular testing of the skin lesion. The patient showed an excellent clinical response to standard anti-tubercular therapy.This case highlights the necessity of maintaining a high index of clinical suspicion for TB in diabetic patients presenting with chronic skin lesions and underscores the vital use of molecular diagnostics, such as cartridge-based nucleic acid amplification test (CBNAAT), in identifying paucibacillary disease.