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Differential Diagnosis & Pitfalls

• Other infections such as sporotrichosis, blastomycosis, coccidioidomycosis, nocardiosis, tularemia, cutaneous tuberculosis, leishmaniasis (Old World and New World), and actinomycosis may have a similar lymphangitic spread from cutaneous inoculation. Exposure and travel history are key for diagnosis.
• Isolated lesions may mimic other cutaneous mycobacterial infections or granulomatous disease.
• Sarcoidosis rarely ulcerates or spreads along lymphatics.
• Cellulitis has a background of erythema and a more rapid onset and spread.
• Mycetoma
• Cutaneous lymphoma may have associated fevers and weight loss.
• Sarcoma may have associated fevers and weight loss.
• Bacterial abscess has an acute onset.
• Pyoderma gangrenosum bleeds easily and appears vascular.
• Vasculitis does not usually have an exophytic growth pattern.
• Superficial thrombophlebitis
• Granuloma annulare rarely ulcerates.
• Hypertrophic lichen planus is highly pruritic and usually located on the shins.
• Foreign body reaction, especially to sea urchin spines or barnacles given the possibility of shared clinical history.
• Cutaneous anthrax
• Majocchi granuloma

• Bacillary angiomatosis can be seen in human immunodeficiency virus (HIV)- / AIDS-infected patients with low CD4 counts or patients who are otherwise immunocompromised.
• Kaposi sarcoma is a consideration in patients with HIV / AIDS.

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