[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.163.92.62. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Citations 0
Off-Center Fold
April 2007

Tender Erythema of the Left Lower Extremity—Diagnosis

Author Affiliations
 

MICHAEL E.MINGMD

Arch Dermatol. 2007;143(4):535-540. doi:10.1001/archderm.143.4.536-b

Punch biopsy specimens from multiple affected areas of the patient's skin demonstrated similar histologic findings. Hematoxylin-eosin–stained sections revealed significant and extensive necrosis involving the reticular dermis and subcutaneous tissue. On higher-power examination, numerous infiltrative fungal organisms with septate and branching hyphae were noted and confirmed by periodic acid–Schiff stain with diastase (Figure 3). Also, multiple enlarged cells (likely dermal fibrocytes or macrophages) with large, purple intranuclear inclusions and surrounding clear halo, consistent with active CMV infection, were scattered throughout the biopsy specimens. Sputum cultures and tissue biopsy specimens yielded A fumigatus. Additional computed tomographic images of the thorax revealed nodular ground glass opacities in the remaining right lung. Voriconazole, lamisil, and ganciclovir therapy was initiated. The patient's clinical course continued to deteriorate. She ultimately received comfort measures and died 1 week after admission.

First Page Preview View Large
First page PDF preview
First page PDF preview
×