Clinical and Experimental Dermatology
Follicular papules and pustules in a patient with pulmonary
K. S. Culpepper
and D. J. B. Kurtzman
Division of Dermatology, University of Arizona, Tucson, AZ, USA; and
Dermpath Diagnostics, Tucson, AZ, USA
A 67-year-old African American man presented to the
emergency department with a 3-week history of pro-
gressive dyspnoea, cough, fatigue, fevers and night
sweats, as well as the unexplained appearance of wide-
spread, asymptomatic skin lesions. The patient had
previously been healthy. He was a long-term resident
of the southwest USA, and had no history of recent
travel, exposure to sick contacts or unexplained weight
loss. He was admitted to the hospital for presumed
On physical examination, monomorphic, follicular
papules and pustules were found on the patient’s
scalp, face, neck, chest, abdomen, back and extremities
(Fig. 1). Lymphadenopathy was absent. Complete
blood count was remarkable for leucocytosis with
absolute eosinophilia. Computed tomography (CT)
scan of the chest showed lobar consolidation, hilar
lymphadenopathy and discrete pulmonary opacities.
Bronchoalveolar lavage (BAL) was performed, but was
inconclusive. Testing for human immunodeﬁciency
virus (HIV) gave negative results.
Histological examination of biopsy specimens obtained
from the patient’s abdomen demonstrated a suppura-
tive and granulomatous folliculitis (Fig. 2a). Numerous
endosporulated spherules were present in the superﬁ-
cial and deep dermis (Fig. 2b).
What is your diagnosis?
Correspondence: Dr Drew J. B. Kurtzman, 1515 N Campbell Avenue, PO
Box 245024, Tucson, AZ 85724, USA
Conﬂict of interest: the authors declare that they have no conﬂicts of
Accepted for publication 1 April 2017
(a,b) Follicular papules and pustules on (a) the poste-
rior scalp and neck, and (b) the thighs.
ª 2017 British Association of Dermatologists
Clinical and Experimental Dermatology (2018) 43, pp336–338