PMC4782408_01
FNAC of nodule (a) reveals dense inflammation (b, c, d: Papanicolaou, x100, x200, x1000, respectively) with pigmented hyphae (e: Papanicolaou, x1000). Biopsy shows similar findings (f, g, h: H and E, x100, x1000, x1000, respectively). Fungal profiles in SDA (i: LPCB, x1000)
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F1
On examination there was a 3 cm x 2 cm slightly-pigmented cutaneous nodule on the right ankle [Figure 1a] without any ulceration, discharging sinus, or tenderness. On microscopy it showed dense mixed inflammation comprising numerous histiocytes, giant cells, and inflammatory granulation tissue [Figure 1b-d]. In addition, numerous pigmented branching and septate fungal hyphae were easily appreciable in the smears [Figure 1e]. Microscopic examination of the slide culture using a lactophenol cotton blue (LPCB) stain [Figure 1i] showed thin brown septate hyphae. Skin biopsy showed dense dermal aggregates of histiocytes and giant cells [Figure 1f] containing numerous thin-pigmented branching fungal hyphae [Figure 1g and h].