case_images: PMC11210314_01
case_images: Clinical features and cytological examination of the present case. At the initial presentation, multifocal ulcerated nodules were observed on thorax, abdomen, and limbs. Some nodules showed serosanguinous discharge (A). On the surface of ulcerative lesions, large numbers of yellowish grains were present (B). In the cytology of ulcerative nodules, inflammatory cells including degenerative neutrophils, macrophages, and multinucleated giant cells, and hyphae indicative of fungal infection were detected (C).
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case_images: PMC11210314_01_fvets-11-1402691-g001.jpg
case_images: fig1
case_images: Upon initial presentation, multifocal ulcerative nodules were observed on the thorax, abdomen, flank, and limbs (Figure 1A). On the surface of the nodules, large numbers of yellowish grains were also noted (Figure 1B). In addition, in cytology of the ulcerative nodules, inflammatory cells mainly consisted of degenerative neutrophils, macrophages, and multi-nucleated giant cells were observed (Figure 1C). Furthermore, fungal hyphae were also noted upon fine needle aspiration of nodules (Figure 1C).
case_images: Histopathological findings of the present case. In histopathological findings, nodular infiltration of inflammatory cells comprising large numbers of macrophages and smaller numbers of neutrophils, lymphocytes, and plasma cells expanded the dermis and panniculus. Hematoxylin and eosin (H&E) staining, x40 (A). The inflammatory infiltration is multifocally centered on irregular fungal organisms which include hyphae (arrow) with bulbous or spore-like dilatation. H&E staining, x400 (B).
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case_images: fig2
case_images: In histopathological analysis we found a severe inflammatory infiltrate that expands in the dermis, comprising large numbers of macrophages and fewer numbers of neutrophils, lymphocytes, and plasma cells (Figure 2A). The inflammation consisted of multifocally centered nodules of irregular fungal organisms which included irregular hyphae with bulbous or spore-like dilatation (Figure 2B).
case_images: The changes in skin lesions after amphotericin B intralesional injection and oral terbinafine administration. Multiple and large ulcerative nodules were present on the thorax, abdomen, and trunk (A,B). Upon three applications of amphotericin B intralesional injection and oral terbinafine administration, ulceration was significantly resolved, and the number and size of nodules were reduced. However, the size of large dome-shaped nodules remained unchanged (C,D).
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case_images: PMC11210314_01_fvets-11-1402691-g003.jpg
case_images: fig3
case_images: Ashish, 20 mg/kg, twice in a day), 0.05% chlorhexidine wipe and ketoconazole ointment (Nizoral cream, Janssen Korea). After 4 weeks of treatments, although pruritic levels were decreased, skin lesions of ulcerative nodules were not resolved, and new nodular skin lesions were observed on the abdomen (Figures 3A,B). After 4 weeks of these medications, ulceration was significantly resolved, and the number and size of nodules were reduced (Figures 3C,D).