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A 12-year-old boy presented with a slowly enlarging plaque, at the site of BCG vaccination (Statens Serum Institute, Danish strain 1331), administered 14 months previously (figure 1). Mantoux testing showed a 14 mm induration and his interferon-gamma (IFN-γ) release assay was negative. Skin biopsy revealed non-caseating dermal granulomata composed of epithelioid histiocytes and Langhans-type multinucleated giant cells (figure 2). No acid fast bacilli were seen. PCR for Mycobacterium tuberculosis complex (includes M bovis) was negative. Based on a clinical diagnosis …
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