Abstract
Vulvar tuberculosis is an exceptionally rare manifestation of extrapulmonary Mycobacterium tuberculosis infection. We describe a 28-year-old woman from Republic of the Philippines presenting with a painful vulvar lesion of 3 months' duration unresponsive to several courses of antibiotics for a presumed sexually transmitted disease. A diagnosis of isolated vulvar Mycobacterial tuberculosis was made based on findings of caseating granulomas on vulvar biopsy and positive mycobacterial culture. The patient achieved complete resolution following standard antituberculous therapy. This case highlights the importance of suspecting tuberculosis in chronic vulvar lesions from endemic areas and underscores tissue biopsy and prolonged culture when initial stains are negative.