PMC5632852_01
Clinical images of our 34-year-old male patient who presented with a 2-month history of rapidly spreading multiple cutaneous lesions. Annular brownish papules and plaques, with or without a scale crust, scattered over the face (a), chest (c/d), and extremities (b/d). Some larger lesions assumed a rupioid aspect (c). Large reddish shallow ulcers in right mammary (c) and right anterior axillary (d) regions. Some lesions drained a seropurulent discharge. Ground grass opacities are seen over the superior segment of the left inferior lobe (e). Complete remission of cutaneous lesions after treatment (f).
CRIID2017-4713140.001.jpg
PMC5632852_01_CRIID2017-4713140.001.jpg
fig1
Clinical examination revealed a febrile and moderately undernourished patient with multiple brownish papules and plaques scattered over the trunk, face, and extremities (Figure 1). Some lesions drained a seropurulent discharge (Figure 1). Chest radiography and computed tomography revealed small nodular and confluent ground grass opacities over the posterior segment of the left upper lobe and superior segment of the left inferior lobe (Figure 1).
(a) Hematoxylin and eosin stain (original magnification 100x) discloses a dermal chronic granulomatous inflammatory reaction, with the presence of Langhans giant cells, epithelioid histiocytes, plasmocytes, neutrophils, and eosinophils. (b) Hematoxylin and eosin stain (original magnification 400x) shows abundant rounded structures located inside multinucleated giant cells and histiocytes. (c) Periodic acid-Schiff stain (original magnification 200x) discloses spherical fungal elements. (d) and (e) Grocott's methenamine silver stain (original magnification 100x and 200x, resp.) unmasks countless 2 to 6 mum darkly stained round to oval, as well as some cigar-shaped, elongated unicellular yeast-like structures, consistent with Sporothrix spp. (f) A cigar-shaped structure (black arrow) and a narrow-based budding yeast (white arrow) are shown in detail.
CRIID2017-4713140.002.jpg
PMC5632852_01_CRIID2017-4713140.002.jpg
fig2
Sporothrix spp. (Figure 2). Skin biopsy samples were also sent for fungal cultures.