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Case for Diagnosis: Granuloma? Presented by Dr. Alexander A. Fisher.
J. C., a man aged 83, presents an eruption of the scalp which has been present for the past six months. He takes bromo-seltzer® (a preparation containing acetanilid and sodium bromide) occasionally.
The eruption consists of ulcerations, thick-crusted lesions, and a few nodules in a conglomerate mass. Serologic tests for syphilis gave negative reactions. Cultures for fungi were sterile.
Histologic examination of a specimen showed a crust overlying a markedly acanthotic epidermis, which was ulcerated in the center. In the cutis there were numerous dilated vessels and a heavy cellular infiltrate composed of small round cells, histiocytes, and some plasma and polymorphonuclear cells. Beneath the ulceration the infiltrate was composed almost entirely of polymorphonuclear cells. There was no evidence of malignancy or syphilis. The histologic diagnosis was pyoderma.
The patient has received injections of penicillin, bismuth, and aureomycin topically