PMC7821815_01
PMC7821815_02
A) erythematous and indurated plaque of lower limbs extending to the abdomen with necrotic ulcer on the right buttock; B) necrotic ulcers on right buttock and posterior side of the left pelvic limb; C) indurated plaque with necrotic ulcer on the inner side of the left thigh associated lymphoedema
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F1
The edges were clearly delineatable by the fingers (Figure 1A), interestingly the lower limbs, the back, and the abdomen. On this large plaque, there were hollow ulcers of variable size (n = 3), with polycyclic contours and fibrinous, necrotic bottom and detached edges (Figure 1B and C). The back of the left foot was the site of lymphoedema (Figure 1C).
A) hematoxylin-eosin-safran staining showing Splendore-Hoeppli phenomenon (yellow open arrow): perivascular granulomas centered by extracellular eosinophilic (X100); B) grocott staining showing granulomas centered by extracellular eosinophilic masses (blue open arrow) and bulky mycelial filaments (yellow open arrow) (X100)
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F2
The granulomas are centered by extracellular eosinophilic masses and bulky mycelial filaments (Splendore-Hoeppli phenomenon), which led to basidiobolomycosis (Figure 2A and B).
A) ulcers of buttock and posterior face of left lower limb healing after mesh grafting and knee flexion correction; B) ulcers of anterior face of left lower limb healing after mesh grafting
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F3
Progression was favorable after 14 weeks of complete medical treatment, lymphoedema, flexum correction, and ulcer healing (Figure 3A and B).