Routine histologic examination of the cutaneous nodule showed dermal abscesses surrounded by a halo of macrophages. Stains for infectious organisms (Fite, Gomori methenamine-silver, Warthin-Starry, and Gram) were noncontributory. Routine histologic examination of the axillary lymph node showed expanded paracortical areas with focal necrosis and a mixed infiltrate. A Warthin-Starry preparation stained clusters of bacilli within the necrotic foci.
The patient's leukocyte count was normal, as was his differential cell count. No bacteria, fungi, or mycobacteria were cultured from blood or lymph node tissue. No antibodies to toxoplasma, histoplasma, blastomyces, cryptococcus, human immunodeficiency virus, or cytomegalovirus were found. IgG antibodies (enzyme-linked immunosorbent assay) to Bartonella were present at a titer of 1:77 (reference range, <1:12).
An Ulcerated Nodule Associated With Lymphadenopathy. Arch Dermatol. 1999;135(8):983-c-988. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-8-dof0899