(BMJ)—A 56-yo man presented w/ lesions to his forearm and hand 1 mo after injuring himself while cleaning his fish tank w/ a meat skewer. Exam: Multiple red, nonhealing lesions. Histology: granulomas. What is the dx?
Granuloma annulare
Botryomycosis
Pyogenic granuloma
Mycobacterium marinum
Vibrio parahaemolyticus
You are correct. Wound cultures grew out Mycobacterium marinum (fish tuberculosis), an infection commonly seen with exposure to stagnant or aquarium water. Tx w/ ethambutol and minocycline was started and the lesions gradually improved over 1 mo. The lesions resolved completely after 6 mo of tx.