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Differential diagnosis includes skin cancer, tertiary syphilis and yaws, leprosy, rhinoscleroma (a very chronic granulomatous infection with Klebsiella rhinoscleromatis), rhinosporidiosis, midline granuloma (a form of T-cell lymphoma), Wegener's granulomatosis, sarcoidosis, skin tuberculosis, infection with the free-living amoeba Balamuthia mandrillaris, chronic nasal cocaine abuse, noma, and fungal infections such cryptococcosis, histoplasmosis and South American blastomycosis (paracoccidioidomycosis). With this last disease, which is a very chronic infection, the lungs are frequently affected in a manner that can mimic tuberculosis. The yeast has typical oval cells with ectospores and can be detected in sputum.
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