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Apr 2012

Plaques on a Butcher’s Fingers—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2012;148(4):531-536. doi:10.1001/archderm.148.4.532-c

Histopathologic analysis showed tuberculoid granulomas with central caseation surrounded by a sparse mantle of lymphocytes in the mid dermis. Multinucleated giant cells were visible. The overlying epidermis showed pseudoepitheliomatous hyperplasia and hyperkeratosis. Findings of special histologic stainings for mycobacteria and fungi, skin cultures, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis were all negative. The results of a complete blood cell count with differential analysis, a complete metabolic panel, and antibody assays for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus were also negative. Chest radiography did not demonstrate any alterations. A PPD test (purified protein derivative) registered a strongly positive (+++) reaction after 48 hours and caused an induration of 14 mm. Based on patient history and clinical, histologic, and laboratory findings, the diagnosis of TVC was made. The patient was successfully treated with rifampicin (450 mg/d) in combination with isoniazid (300 mg/d) for 4 months. At a 1-year follow-up, the patient was free of disease.

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