some cases, mycobacterial DNA may be detected in skin lesions via PCR. 1 This finding has yet to be consistently demonstrated in EI associated with nontuberculous mycobacteria, such as M. avium. A positive IGRA is expected in tuberculosis-associated EI. However, nontuberculous mycobacterial species are associated with a positive IGRA in 52% of cases and only 2% of cases of M. avium, making identification of the extracutaneous infection particularly challenging in atypical cases of EI. 5 Advanced imaging and even surgical pathology may be necessary, as demonstrated by our case.We highlight this case to increase awareness of an unusual presentation of EI and underscore the potential difficulty in identifying an underlying mycobacterial infection. Persistent workup may be necessary for diagnosis.
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