Jeremy is a 52-year-old office manager who presents with painless erythematous cutaneous nodules on the left thumb and dorsoradial forearm that have developed over the past two weeks.

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<p>Jeremy is a 52-year-old office manager who presents with painless erythematous cutaneous nodules on the left thumb and dorsoradial forearm that have developed over the past two weeks (pictured).</p><p>Six weeks previously, he injured his left thumb pad, piercing it with a fishhook as he was reeling in a catch on a NT fishing trip.</p><p>Jeremy is typically well, with no past history of note. He has never travelled or resided outside Australia.</p><p>Jeremy is systemically well, with no associated fever, cough or lymphadenopathy.</p><p>Swabs of the thumb wound are negative.</p><p>An incisional tissue biopsy from one of the nodules reveals cutaneous inflammatory change without caseating granuloma.</p><p>Culture of this tissue demonstrates acid-fast bacilli.</p><p>Chest and upper-limb X-rays are unremarkable.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.