PMC7169360_01
Three alopecic nodules on the top of the head with a mild amount of crusts present centrally
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Dermatological examination revealed several eroded nodules on the top of the head, pinna, chin, and on the margin and ventral aspect of the tongue, as well as on the footpad of the right forelimb (Figures 1-3).
Tongue with three nodules on the ventral aspect and ulceration on the margin
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Dermatological examination revealed several eroded nodules on the top of the head, pinna, chin, and on the margin and ventral aspect of the tongue, as well as on the footpad of the right forelimb (Figures 1-3).
Right thoracic limb showing papular lesions and crusts on the carpal paw pad and an interdigital nodule
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Dermatological examination revealed several eroded nodules on the top of the head, pinna, chin, and on the margin and ventral aspect of the tongue, as well as on the footpad of the right forelimb (Figures 1-3).
Right eye with anterior uveitis with ventral keratic precipitates
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The right eye presented with anterior uveitis with keratic precipitates (Figure 4).
Microscopic examination of fine-needle aspirate cytology: histiocytes with Cryptococcus neoformans. Note the spherical yeasts surrounded by unstained capsules giving the appearance of 'soap bubbles' (arrows) (Diff-Quik, 1000x magnification).
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Samples were stained with Diff-Quick (RAL Diff-Quik; RAL Diagnostics) and cytology showed histiocytes, giant cells, neutrophils and vast numbers of spherical yeasts with large, non-staining refractile capsules resembling cryptococcosis (Figure 5).
(a) Haematoxylin and eosin photomicrograph (x 5 magnification) revealing diffuse nodular non-encapsulated infiltrates affecting the dermis. Note the presence of multiple clear spaces in the dermis. (b) Same biopsy specimen (x 20 magnification) showing abundant yeast-like organisms with an unstained capsule (arrows). Pyogranulomatous infiltrate evident on biopsy sample.
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The histopathology showed ulcerated epidermis, nodular encapsulated inflammatory infiltrates with histiocytes, giant cells and neutrophils (Figure 6).
(a) Periodic acid-Schiff (PAS) stain photomicrograph (x  2.5 magnification) tissue sample specimen showing ulcerated epidermis, and well-demarcated and non-encapsulated inflammatory infiltrate affecting the dermis. (b) PAS stain photomicrograph (x 20 magnification) with numerous spherical yeast-like organisms with prominent unstained capsule (examples on selected area). (c) PAS stain photomicrograph (x 40 magnification) with countless Cryptococcus neoformans
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Moreover, periodic acid-Schiff (PAS) staining was positive (Figure 7), and fungal culture and PCR test confirmed the diagnosis of Cryptococcus neoformans.
Small nodule on the ventral aspect of the tongue
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Dermatological examination revealed a small nodule on the tongue (Figure 8), and there were no other abnormalities.