Primary inoculation tuberculosis A case of primary inoculation tuberculosis of the finger is described, in which Mantoux test conversion reverted after prompt surgical and medical treatment. The pathology of primary inoculation tuberculosis is reviewed briefly, and the rationale for excision of the early tuberculous lesion is discussed.

Robert P. Hooker, M.D., Thomas J. Eberts, M.D., and James A. Strickland, M.D., Indianapolis, Ind.

Primary inoculation tuberculosis is an affliction almost wholly restricted to autopsy personnel and laboratory workers.! Primary cutaneous tuberculosis has been reported sporadically in children following minor skin trauma,2-4 but lack of history of exposure to M. tuberculosis usually results in delayed diagnosis. With the decline in incidence of tuberculosis in the general population, the de-emphasis of the autopsy in medical schools and in pathological practice. and the advent of From the Department of Pathology, Indiana University Medical Cen· ter, and St. Vincent's Hospital, Indian apolis, Ind. Received for publication July 18, 1978. Reprint requests: Robert P. Hooker, M.D., Department of Pathology , Indiana University Medical Center, 1100 W. Michigan St.. Indianapolis, IN 46202

effective antituberculous drug therapy, few reports of primary inoculation tuberculosis have appeared. We present the following case as a warning and to suggest an effective approach to management.

Case report A 31-year-old male pathology resident, while petforming an autopsy on a patient with cavitary pulmonary tuberculosis , pricked the medial aspect of his left middle finger on the sharp point of a rib . The surgical glove appeared to remain intact. Three weeks from the seemingly insignificant incident, a mildly pruritic; slightly erythematous, 5.0 mm diameter papule was noted at the site (Fig. I). There was no adenopathy. One day later the lesion appeared to be pustular and, with a high index of suspicion, the lesion was incised superficially for culture. Two drops of clear fluid were ex-

Fig. 1. Gross photograph of tuberculous lesion . medial aspect. left third finger.

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THE JOURNAL OF HAND SURGERY

0363-5023/79/030270+04$00.40/0 © 1979 American Society for Surgery of the Hand

Vol. 4, No . 3 May, 1979

Primary inoculation tuberculosis

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Primary inoculation tuberculosis.

Primary inoculation tuberculosis A case of primary inoculation tuberculosis of the finger is described, in which Mantoux test conversion reverted afte...
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