Prosector's wart

Prosector's wart or tuberculosis verrucosa cutis (TVC), is a rash of small, red papular nodules in the skin that may appear 2-4 weeks after inoculation by Mycobacterium tuberculosis in a previously infected and immunocompetent individual.

It is so called because it was a common occupational disease of prosectors, the preparers of dissections and autopsies. Reinfection by tuberculosis via the skin, therefore, can result from accidental exposure to human tuberculous tissue in physicians, pathologists and laboratory workers; or to tissues of other infected animals, in veterinarians, butchers, etc. Other names given to this form of skin tuberculosis are anatomist's wart and verruca necrogenica (literally, generated by corpses).

TVC is one of the many forms of cutaneous tuberculosis, such as the tuberculous chancre (which results from the inoculation in people without immunity, and the reactivation cutaneous tuberculosis (the most common one, which appears in previously infected patients). Other forms of cutaneous tuberculosis are: lupus vulgaris, scrofuloderma, lichen scrofulosorum, erythema induratum and the papulonecrotic tuberculid.

Because the TVC's entry point usually is the site of a trauma, wound or puncture in the skin (during an autopsy, for example), the most frequent site for the wart are the hands. But it can occur anywhere in the skin, such as in the sole of the feet, in the anus, and, in the case of children from developing countries, in the buttocks and knees. This is because children from countries of high incidence of tuberculosis can contract the lesion after contact with tuberculous sputum, by walking barefoot, sitting or playing on the ground.

When recent, the skin lesion has the outside appearance of a wart or verruca, thus it can be confused with other kinds of warts. It evolves to an annular red-brown plaque with time, with central healing and gradual expansion in the periphery. In this phase, it can be confused with fungal infections such as blastomycosis and chromoblastomycosis.

The diagnosis is confirmed by a skin biopsy and a positive culture for acid-fast bacilli. A PPD test may also result positive.

Therapy for cutaneous tuberculosis is the same as for systemic tuberculosis, and usually consists of a 4-drug regimen, i.e., isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin.

Reference
Goldman, G.; Bolognia, J.L. Pinpointing cutaneous signs of tuberculosis: is it a common wart, or tuberculosis verrucosa cutis? Journal of Critical Illness,  Dec. 2002.