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July 2010

An Exophytic Nasal Nodule—Diagnosis

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Arch Dermatol. 2010;146(7):789-794. doi:10.1001/archdermatol.2010.150-b

Histopathologic findings revealed pseudoepitheliomatous hyperplasia of the epidermis with pustulation of the epithelium and multinucleated giant cells within the thickened walls of follicular structures. The dermis exhibited a mixed infiltrate of plasma cells, lymphocytes, and neutrophils. The giant cells contained spheres 30- to 60-μm in diameter, which stained positively with Gomori methenamine silver and Alcian blue/periodic acid–Schiff. The combination of this observed endosporulation, along with DNA probe analysis, confirmed the diagnosis of coccidioidomycosis. Findings from subsequent sinus and chest radiographs were normal. After a course of oral ketoconazole, the lesions resolved without scarring.

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