PMC5529090_01
Photo of the patient showing the multiple cauliflower-like lesions.
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He appeared cachectic on presentation and had numerous cauliflower-like lesions on his face (Figure 1) and extensive adenopathy including the cervical, supraclavicular, axillary, and inguinal regions.
CT chest showing extensive hilar and mediastinal adenopathy (red arrow heads).
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There was radiologic evidence of extensive mediastinal and hilar adenopathy and splenomegaly measuring 14.0 cm on computed tomography (Figures 2 and 3).
CT abdomen showing enlarged spleen measuring 14.1 cm.
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There was radiologic evidence of extensive mediastinal and hilar adenopathy and splenomegaly measuring 14.0 cm on computed tomography (Figures 2 and 3).
PAS stain showing multiple spherules with endospores (arrows).
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Pathology of one node reported granulomatous inflammation with giant cell reaction and focal necrosis with fungal elements most compatible with Coccidioides species (Figure 4).