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(a) Mass at right deltoid and (b) well-defined erythematous plaque at right clavicle.
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A large painful erythematous mass approximately 16 x 18 centimeters in size at right deltoid with swelling of the right arm was noted, resulting in limited range of motion (Fig. 1a). A hard well-defined erythematous plaque at the right clavicle 5 x 6 centimeters in size was also observed (Fig. 1b).
Magnetic resonance imaging of the right shoulder on axial (a) T1-and (b) short tau inversion recovery (STIR) images show infiltrative lesion in the subcutaneous tissue (arrow) and deltoid muscle (open arrow), and enlarged axillary lymph nodes (arrowheads).
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The magnetic resonance imaging (MRI) showed infiltrative lesion in the subcutaneous tissue and muscles, as well as right axillary lymphadenopathy (Fig. 2).
Pathological findings show granular eosinophilic island and fungal hyphae. with Splendore-Hoeppli phenomenon (a) Hematoxylin and Eosin stain (200 x) and. (b) Grocott's methenamine silver stain shows sparsely septate hyphae (400 x). Arrow indicates fungal hyphae.
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The Grocott methenamine silver (GMS) stain showed fungal hyphae (Fig. 3).
Lesion after treatment (a) 1 week, (b) 3 months.
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The lesion gradually regressed, and follow-up images were taken at one week as well as three months after treatment (Figs. 4a and 4b, respectively).