Tuberculosis is highly prevalent in developing world. Post primary tuberculosis occurs in the setting of depressed immunity commonly affecting the lungs. Reactivation of tuberculosis concomitantly at different non-pulmonary sites is very uncommon. Here we report an immunocompetent male with rheumatoid arthritis presented with reactivation of cutaneous and meningeal tuberculosis while on low dose methotrexate therapy. The case report highlights the fact that the treating clinician should be vigilant enough to suspect reactivation of latent tuberculosis even with non biological disease modifying anti rheumatoid drugs therapy in tropical world.
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