PMC3285031_01
Cutaneous lesions initially presented as small papules, enlarged to larger papules with central necrotic umbilications. They were predominantly found on the face and extremities.
1471-2334-12-28-1.jpg
PMC3285031_01_1471-2334-12-28-1.jpg
F1
Generalized non-pruritic erythrematous papules and nodules with central umbilication were found over the face, body, and extremities (Figure 1).
Radiologic evidences of osteolytic lesions of the extremities. a. Multiple osteolytic lesions are noted along the metaphyseal line of the 2nd to 4th metacarpophalangeal joints (arrow) with pericarticular osteopenia of the wrist and metacarpophalangeal joints. Large osteolytic lesions are also noted at right distal radius and ulnar (arrows). No widening of both wrist joint spaces. Sharp bony cortex of both radius and ulnar. b. Multiple osteolytic lesions are noted at right calcaneous (arrow). No widening of both ankle joint spaces. Sharp bony cortex of both tibia and fibula.
1471-2334-12-28-2.jpg
PMC3285031_01_1471-2334-12-28-2.jpg
F2
Roentgenograms of both wrists and ankles showed multiple round radiolucent defects of the bones (Figure 2).
Photomicrograph of Penicillium marneffei (courtesy of Kornkanok Sukapan) in the skin lesion section stained with Grocott Methenamine Silver. Numerous intracellular and extracellular, round to oval, elongated, thin-walled yeast-like organisms. The characteristic transverse septum (arrows) within the yeast cell is seen. Magnification, x 1000.
1471-2334-12-28-3.jpg
PMC3285031_01_1471-2334-12-28-3.jpg
F3
Tissue sections from skin biopsy stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and Grocott methenamine silver (GMS) stain revealed numerous intracellular and extracellular, round to oval, elongated, thin-walled yeast cells with central septation (Figure 3).