PMC5297266_01
8 x 10 cm confluent nodular swelling over the dorsum of the hand
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F1
Multiple swellings were coalesced to form a large fluctuant mass measuring 8-10 cm, present on the dorsum of right hand [Figure 1].
Multiple cystic swellings over the feet
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F2
While performing an excisional biopsy, there was purulent discharge from the biopsy site, and hence all the lesions were incised [Figure 2].
Pigmented fungi on Sabouraud's dextrose agar
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F3
Cyst material was sent for HPE Gram stain was negative for bacteria and on culture with Sabouraud's dextrose agar, pigmented fungi were identified and lactophenol cotton blue showed Exophiala jeanselmi species [Figure 3].
(a) (H and E, x10) Granuloma in the dermis composed of epithelioid cells, lymphocytes, and fibroblasts. (b) (H and E, x100) closer view
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F4
Cyst material for HPE showed multiple granulomas and Grocott's methanamine silver (GMS) stain showed broad brownish filaments [Figures 4 and 5].
(a) Granulomas with pigmented fungal growth (scanner view - GMS) (b) Pigmented fungal filaments (High power view - GMS)
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F5
Cyst material for HPE showed multiple granulomas and Grocott's methanamine silver (GMS) stain showed broad brownish filaments [Figures 4 and 5].