Introduction: CTB is a rare manifestation of TB,accounting for 1–1.5% of extrapulmonary cases.It presents with polymorphous skin lesions,including papules,nodules,ulcers,is more prevalent in low-income,HIV-+, immunosuppressed populations. Case:18 yrs old,male has nasal congestion,headache,dry mouth,anxiety and is embarrassed of it.The patient was diagnosed with CTB and received a full course of anti-tuberculosis treatment.After treatment,the skin lesion completely healed six months,but atrophic scarring and nasal deformity remained.VAS score7-9.CT:S-shaped deviation of the nasal septum,Inf turbinate swelling. Surgery:The patient’s own cartilage was used to improve the airway and structural support:Spreader,Columellar,Derotation graft.After surgery,nasal obstruction resolved,the external nasal shape was corrected.The patient was satisfied with the appearance, VAS score 4/9. Discussion:The rarity of nasal involvement in LV underscores the importance of considering CTB in the differential diagnosis of chronic, non-healing skin lesions, especially in TB-endemic regions.Nguyen et al. (2023) reviewed the pathogenesis, risk factors, and treatment options for CTB, emphasizing the need for improved diagnostic and therapeutic strategies. Conclusion:CTB, particularly ulcerative lupus vulgaris, can lead to significant deformities if not diagnosed and treated early.A high index of suspicion,combined with histopathological confirmation,is crucial for timely intervention and prevention of complications.