A Veterinarian’s Painful Rash

A 59-year-old veterinarian presents with a chronic, painful hand rash. Biopsy is inconclusive, but advanced testing reveals an unexpected infectious cause.

Interferon-γ release assay


A 59-year-old veterinarian presented to the dermatology clinic with a 1-year history of a painful rash on his right hand (left) and right index finger (middle). He had no other symptoms. Biopsy of the lesion on the dorsum of the hand revealed pseudoepitheliomatous hyperplasia and granulomas in the dermis (right). Metagenomic next-generation sequencing of the tissue identified Mycobacterium tuberculosis, and a diagnosis of tuberculosis verrucosa cutis was made. Which of the following tests is most likely to support this diagnosis?

What is the most likely diagnosis?

HPV genotyping
Interferon-γ release assay
KOH staining
Rapid plasma reagin
Tissue culture

Cutaneous Tuberculosis, Interferon-γ release assay, Mycobacterium tuberculosis, Pseudoepitheliomatous hyperplasia, Tuberculosis verrucosa cutis

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