Gummatous tuberculosis, also known as metastatic tuberculous abscesses, represents an uncommon manifestation of cutaneous tuberculosis, marked by the presence of persistent subcutaneous abscesses. We report the case of a malnourished Malagasy child with no family history of tuberculosis, presenting with chronic skin lesions lasting about a year, alongside systemic symptoms such as low-grade fevers, night sweats and weight loss. Despite initial negative microscopy for Koch's bacilli, the diagnosis was confirmed by GeneXpert PCR analysis. This case highlights the diagnostic difficulties associated with tuberculosis in high-burden countries. The chronicity of the skin lesions, the endemicity of tuberculosis, the child's immunosuppression from malnutrition and systemic symptoms raised clinical suspicion. Chronic abscesses with unusual presentations should prompt consideration of gummatous tuberculosis, particularly in endemic areas, where diverse and prolonged cutaneous manifestations warrant thorough evaluation.
