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.
Verrucous Nodules on the Toes of a Renal Transplant Recipient—Diagnosis. Arch Dermatol. 2007;143(5):653-658. doi:10.1001/archderm.143.5.653-e