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Erythematous Papules on the Leg—Diagnosis
Arch Dermatol. 2006;142:921.
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Diagnosis: Protothecosis.
MICROSCOPIC AND LABORATORY FINDINGS
The hematoxylin-eosin–stained sections revealed a prominent necrotizing granulomatous inflammation in the dermis, with numerous spherical capsulated organisms with pale-pink outlines and clear spaces representing endospores within multinucleated giant cells. Special stains, including methenamine-silver and periodic acid–Schiff, showed structures that were consistent with Prototheca organisms. Fite stains were negative for acid-fast bacilli, and a gram stain was negative for bacteria.
The diagnosis was confirmed by culture on Sabouraud dextrose agar, which yielded smooth, creamy, yeastlike colonies with a grouped arrangement. Spores and sporangia were observed forming a morulalike structure, typical of Prototheca.
DISCUSSION
Protothecosis is a rare infection that is caused by the achlorophyllic, saprophytic algae of the genus Prototheca. Three species have been identified (Prototheca wickerhamii, Prototheca zopfii, and Prototheca stagnora), but only the first 2 are known to be agents of disease in humans and animals.1 Prototheca organisms, which are present mainly in sewage, . . . [Full Text of this Article]
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