PMC3938368_01
Necrotic papules and follicular pustules
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During the clinic exam, polymorphism of skin lesions was noted with pustules of follicular distribution, papules with central necrosis, erythematous-infiltrated plaques covered with pustules and ulcerated plaques, located on the face, trunk, abdomen and limbs, associated with left knee arthritis (Figures 1, 2 and 3A).
A and B) Erythematous plaque with follicular pustules on
the nose. C) Ulcerated plaque on forehead. D) Ulcerated
erythematous infiltrated plaque on the back
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During the clinic exam, polymorphism of skin lesions was noted with pustules of follicular distribution, papules with central necrosis, erythematous-infiltrated plaques covered with pustules and ulcerated plaques, located on the face, trunk, abdomen and limbs, associated with left knee arthritis (Figures 1, 2 and 3A).
A) Left knee monoarthritis. B) Osteolytic lesion in the
patella (white arrow)
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During the clinic exam, polymorphism of skin lesions was noted with pustules of follicular distribution, papules with central necrosis, erythematous-infiltrated plaques covered with pustules and ulcerated plaques, located on the face, trunk, abdomen and limbs, associated with left knee arthritis (Figures 1, 2 and 3A). Left knee x-ray showed reduction of joint space and osteolytic patellar lesion (Figure 3B).
Biopsy of the synovial membrane: Paracoccidioides brasiliensis (KOH)
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Both exams identified round cells, birefringent, with multiple buddings compatible with P. brasiliensis (Figure 4).
Histopathology of the kidney: Paracoccidioides brasiliensis (Grocott)
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Necropsy revealed involvement of lungs, liver, spleen, kidneys, adrenals and bone marrow, in addition to the previously described sites (Figure 5).