Clinical findingsA 67‐year‐old African American man presented to the emergency department with a 3‐week history of progressive dyspnoea, cough, fatigue, fevers and night sweats, as well as the unexplained appearance of widespread, 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 community‐acquired pneumonia.On physical examination, monomorphic, follicular papules and pustules were found on the patient's scalp, face, neck, chest, abdomen, back and extremities (Fig. ). 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.(a,b) Follicular papules and pustules on (a) the posterior scalp and neck, and (b) the thighs.Histopathological findingsHistological examination of biopsy specimens obtained from the patient's abdomen demonstrated a suppurative and granulomatous folliculitis (Fig. a). Numerous endosporulated spherules were present in the superficial and deep dermis (Fig. b).(a) Suppurative and granulomatous folliculitis with a fungal spore adjacent to
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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