A small, raised, erythematous lesion developed on the dorsum of the hand of a 35-year-old man who worked in a pet shop. Over a period of three months, there was progressive spreading of nodular lesions from his hand to just above his elbow. There was no epitrochlear or axillary adenopathy. The patient did not have fever or other symptoms. His duties included cleaning fish tanks daily, which he did without wearing protective gloves. Needle aspiration of a nodule recovered thick, purulent fluid that was positive for acid-fast bacilli.
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