REPORT OF A CASE
A 30-year-old black man presented with a 3-month history of multiple skin lesions. These had progressively enlarged, despite a course of oral antibiotics. The patient had also noticed a left testicular mass of 1 month's duration, which had initially been tender. His health had otherwise been good, with the exception of an upper respiratory tract infection 3½ months before presentation.Physical examination revealed verrucous plaques located on the posterior aspect of the scalp, left lower eyelid, upper lip, right flank, left forearm, left thumb, and left knee (Figs 1 and 2). Subcutaneous nodules were present in the anterior and posterior axillary areas. A small nontender mass was palpable in the left epididymis.A punch biopsy specimen was obtained from the left forearm (Figs 3 through 5).What is your diagnosis?
North American blastomycosis.
Figures 3 and 4 exhibit hyperkeratosis, parakeratosis, and
Leet NA, Parker CM. Multiple Verrucous Skin Lesions. Arch Dermatol. 1991;127(5):726. doi:10.1001/archderm.1991.01680040135021