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Images in Dermatology
August 10, 2022

Cutaneous Blastomycosis

Author Affiliations
  • 1Division of Dermatology, Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois
JAMA Dermatol. 2022;158(9):1064. doi:10.1001/jamadermatol.2022.3151

A man in his 30s presented with an enlarging plaque on the thigh that started as a nodule 2 years earlier. He recalled no preceding trauma. A review of systems revealed only right knee pain. Several months before the lesion appeared, he was evaluated for nonresolving pneumonia. The results of an exhaustive infectious workup were negative, and his symptoms resolved with treatment with empirical antibiotics. Physical examination revealed a 30 × 23–cm verrucous oval plaque with central atrophy on the right thigh (Figure, A). Results of HIV testing were negative. Imaging results of the chest, abdomen, and knee were normal. Histopathologic examination of the lesion showed pseudoepitheliomatous hyperplasia overlying suppurative granulomas (Figure, B). Gomori methenamine silver staining revealed multiple broad-based budding yeast. Fungal culture grew Blastomyces dermatitidis. The lesion healed with residual atrophy after treatment with itraconazole, 200 mg, twice daily, was administered.

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