PMC6399754_01
The patient's face was diffusely infiltrated with scaly, verrucous, hyperpigmented thick plaques, producing a leonine facies appearance.
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On examination, her face was diffusely infiltrated with scaly, verrucous, hyperpigmented plaques, producing leonine facies (Figure 1).
The patient's torso and extremities, showing non-blanching, purpuric, violaceous-brown papules and plaques of varying sizes with blanchable, erythematous haloes.
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These were haloed by blanchable, erythematous patches (Figure 2).
A hematoxylin and eosin-stained section at 40x magnification shows numerous parasitized macrophages containing small, ovoid yeast-like organisms.
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A lesional skin biopsy, processed with hematoxylin and eosin staining, revealed a dermal infiltrate of histiocytes containing numerous ovoid, yeast-like organisms (Figure 3).
Staining with Grocott's methenamine silver at 40x magnification highlights Histoplasma capsulatum within macrophages, allowing differentiation from leishmaniasis which does not stain.
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These organisms were more clearly defined using periodic acid-Schiff, Grocott's methenamine silver (Figure 4), and Giemsa stains, supporting a fungal etiology.