PMC6487756_01
21 December 2017: unilateral sporotrichoid pattern of non-tender infiltrated plaques of the right foot and lower leg, on a background of chronic atrophic and hyperpigmented scarring:(a) frontal view and (b) medial view.
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A second skin biopsy was performed in December 2017 (Figure 1).
Biopsy of a nodule on the right lower limb. (a) Hematoxylin-eosin stain (40x magnification) demonstrated skin ulceration, extensive necrosis, and a suppurative granulomatous inflammatory process involving the dermis and the hypodermis, associated with fibrous reorganization. (b) Modified Ziehl-Neelsen stain (600x magnification) revealed rare rod-shaped organisms (black arrows) dispersed among areas of suppurative granulomatous inflammation.
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Modified Ziehl-Neelsen staining was once again performed, and this revealed the presence of rod-shaped microorganisms compatible with atypical mycobacteria (Figure 2).