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January 2010

Ulcerated Facial Nodules in a Renal Transplant Recipient—Diagnosis

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Arch Dermatol. 2010;146(1):81-86. doi:10.1001/archdermatol.2009.333-b

Histologic studies showed pseudoepitheliomatous hyperplasia with neutrophilic abscesses (Figure 2). Staining revealed branching, filamentous, weakly acid-fast organisms. The organisms were gram positive, Gomori methenamine silver positive, acid-fast (Ziehl-Neelsen) negative, and modified acid-fast (Fite-Faraco) positive (Figure 3). A skin culture specimen grew Nocardia species; however, polymerase chain reaction identification results by both the 65 kg-Da heat shock protein and the 16s-ribosomal sequencing techniques were not close to any recognized species.

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