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Arch Dermatol. 2007;143(5):653-658.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Diagnosis: Cutaneous blastomycosis.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

Histologic examination of the hematoxylin-eosin–stained biopsy specimen revealed suppurative granulomatous inflammation and scattered giant cells. Because a fungal origin was suspected, Gomori methenamine silver (Figure 3) and periodic acid–Schiff staining was performed and revealed numerous broad-based budding yeasts with thick double-contoured cell walls, consistent with blastomycosis. Staining was negative for acid-fast bacilli. Evaluation revealed no pulmonary or other systemic lesions. A sputum culture was mildly positive for Candida albicans. Samples of bronchoalveolar lavage fluid were negative for fungal elements, acid-fast bacilli, cytomegalovirus, and Pneumocystis carinii, and urine samples were negative for Histoplasma, Blastomyces, and Cryptococcus antigens.

Figure appears in full text version. Figure 3.

The patient was treated with oral fluconazole, without improvement. Topical 5% imiquimod cream was added to alternate-day therapy with topical 1% naftifine hydrochloride cream, also without improvement. Owing to the patient's status as an immunosuppressed renal transplant recipient who was receiving hemodialysis, itraconazole and amphotericin B . . . [Full Text of this Article]

DISCUSSION