Case #36, 20th Annual Uniformed Services Dermatology Seminar

Presenter: Mark S. Lee, MAJ, MC, USA

A 37 year old male complained of a 4-month history of enlarging lesions on the left side of his nose and right side of his abdomen. He stated that these sites had been traumatized by a piece of guitar when he was involved in a fight. He had also noticed a lump on his left chest.

PE: Approximately 2 X 3 cm ulcerated red nodule on the left nasal sidewall. A 3 X 5 cm erythematous verrucous appearing plaque was noted on the right side of his abdomen. Also, a 3 X 4 cm tender dermal nodule was noted on the left side of his chest near the mid-axillary line.

Labs: Fungal culture grew Blastomyces dermatitidis

Histopathologic findings: Suppurative and granulomatous dermatitis with pseudoepitheliomatous hyperplasia was seen. Fungal stain (GMS) revealed 12-15 micron sized, round to oval fungi.