PMC5884637_01
A-E: Clinical and Histopathologic features of invasive fungal infection (A) Leg ulcer with black central eschar, which grew Exserohilum sp. B: Epidermal ulceration with fibrin crust (top right) with several thrombosed blood vessels (arrows) and purple fluffy material representing fungal organisms seen throughout the dermis. C: Numerous nonpigmented branching hyphae and rare conidia (arrow head). Branching at right-angles can be easily appreciated (arrows). D: Grocott's methenamine silver (GMS) stain highlights the angioinvasive fungal organisms with numerous septate (arrow heads) hyphae and several intravascular conidia (arrows). The vessel wall is indicated by the dashed line. E: Some hyphae are arranged parallel to each other, with branching at right angles, resulting in H-shaped structures (arrows). Several conidia (arrows) are also seen.
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F1
Physical examination by a local physician revealed a painful erythematous ulcerated lesion over left lower extremity with central black eschar (Fig. 1A). Scrotal skin biopsy demonstrated extensive dermal and angioinvasion by septate hyphal organisms Fig. 1(B-E).