Tuberculosis Verrucosa Cutis of the Hand: An Occupational Hazard

Abstract

Tuberculosis verrucosa cutis is an uncommon paucibacillary form of cutaneous tuberculosis caused by exogenous inoculation of Mycobacterium tuberculosis into the skin of a previously sensitized individual. It typically affects trauma-prone exposed areas and may be associated with occupational exposure. We report the case of a 35-year-old male cattle handler who presented with a slowly progressive painless verrucous plaque over the dorsum of the right hand for eight months, beginning at the site of a healed cut sustained during handling of livestock and raw animal products. Examination revealed a solitary well-demarcated hyperkeratotic verrucous plaque measuring 4 × 3 cm, without ulceration, bleeding, discharge, tenderness, or regional lymphadenopathy. Routine haematological and biochemical investigations were within normal limits, while chest radiography and abdominal ultrasonography were unremarkable. Bacterial and fungal cultures were negative. Mantoux test showed 18 mm induration, whereas Ziehl–Neelsen and periodic acid–Schiff stains were negative. Histopathological examination of the excised lesion demonstrated marked hyperkeratosis, acanthosis, papillomatosis, pseudoepitheliomatous hyperplasia, and well-formed epithelioid granulomas with Langhans giant cells and lymphocytic infiltrates, without necrosis. Based on the characteristic clinical appearance, occupational history, positive tuberculin reactivity, and supportive histopathology, a diagnosis of tuberculosis verrucosa cutis was established. The patient was treated with standard antitubercular therapy, following which the lesion showed progressive flattening and complete clinical resolution with mild residual post-inflammatory pigmentation. This case highlights the importance of considering tuberculosis verrucosa cutis in chronic verrucous plaques over exposed sites in individuals with repeated occupational trauma and emphasizes the value of clinicopathological correlation for timely diagnosis and effective treatment