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August 1999

Symmetrical Hemorrhagic Bullae in an Immunocompromised Host

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Arch Dermatol. 1999;135(8):983-a-988. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-8-dof0899

A skin biopsy specimen demonstrated numerous round to ovoid spores, 4 to 10 µm in diameter, surrounded by a wide gelatinous capsule. The spores stained positively with periodic acid–Schiff.

Because of the patient's multiple medical problems, fluconazole rather than amphotericin therapy was initiated on hospital day 5. The infection symmetrically spread to involve both upper extremities, sparing the distal aspect of the fingers and the lower extremities. Within 24 hours, the patient became obtunded, and a do-not-resuscitate order was obtained by her family. Postmortem examination demonstrated extensive pulmonary and meningeal infection with Cryptococcus neoformans.

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