(BMJ) - A 40-yo man presented w/ a lesion on his nose 1 wk after cutting it while swimming in a pool. It began as a pustule and progressed to an inflammatory nodule. Biopsy showed caseating granulomata. What is the diagnosis?
Histoplasmosis
Mycobacterium marinum
Schistosomiasis
Foreign body reaction
Epidermal cyst
You are correct. Swimming pool granulomata are caused by Mycobacterium marinum, an organism that can be resistant to chlorine in pools. Inoculation into damaged skin is required. The patient responded well to high-dose doxycycline.
(BMJ) - A 35-yo man complained of multiple boils in his perianal region that were unresponsive to repeated I & D and antibiotics over 4 yrs. Exam revealed fistula-in-ano w/ multiple external openings. The cause was confirmed on histopathologic exam. What is it?
Crohn disease
Tuberculosis
Gonorrhea
Anal carcinoma
Syphilis
You are correct. Tuberculosis was confirmed on histopathologic exam of one of the tracts. A fistula-in-ano w/ multiple openings is typical of ano-rectal tuberculosis, for which the diagnosis is often delayed. The pt responded well to antitubercular tx.