PMC7235660_01
View of the patient's left upper arm prior to antifungal treatment showing cribriform ulceration.
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A 78-year-old male presented with a non-healing left arm ulcer in June 2017 (Figure 1).
Biopsy from November 2018. (a) Hematoxylin and eosin stain (magnification 400x) showing intra-histiocytic and extracellular yeasts measuring from 3 to 5 microns, resembling Histoplasma organisms. (b) Periodic acid-Schiff stain (magnification 400x) showing yeasts measuring 3-12 microns in diameter within histiocytes. (c) Grocott's methenamine silver stain (magnification 400x).
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A 4-mm punch biopsy of the ulcer edge showed numerous three- to four-micron intra-cytoplasmic yeasts within histiocytes (Figure 2(a)). Hundreds of intracellular organisms were PAS stain-positive and Grocott's methenamine silver stain-positive (Figure 2(b) and (c)), ranging from 3 to 12 microns with some budding yeasts.
View of the patient's left upper arm 3 months post-treatment.
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Treatment continued for 4 months leading to complete wound regression and healing of the left arm (Figure 3).
Biopsy from June 2017. (a) Hematoxylin and eosin stain from the biopsy showing suppurative dermatitis below an ulcer, in which focally a multinucleated histiocyte is visible (magnification 400x). (b) A single PAS-positive yeast organism measuring 4-6 microns found on re-examination (magnification 640x).
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