PMC5842979_01
(a) Multiple pearly papules and nodules with necrotic centres on the face and neck, (b) well-circumscribed verrucous papules and plaques on the ear and (c) a supraglottitis with ulceration on the lingual surface of the epiglottis.
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In addition, there were verrucous plaques and nodules on the ears and upper limbs (Figure 1a and b). A fibre-optic laryngoscopy revealed a supraglottitis with ulceration on the lingual surface of the epiglottis (Figure 1c).
(a) Haematoxylin-eosin 40x - shows features of a pandermal granulomatous inflammatory reaction comprising aggregates of epithelioid histiocytes and Langerhans giant cells; (b) PAS stain 40x reveals the presence of intracellular uninucleate oval yeast-like, narrow-neck budding fungal organisms; and (c) Grocott-Gomori methenamine silver stain 40x - shows a narrow-neck budding fungal organism.
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Grocott-Gomori methenamine silver and PAS stains revealed a relative paucity of intracellular oval, narrow-neck budding fungal organisms morphologically in keeping with Histoplasma capsulatum var. capsulatum (Figure 2a and b).