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case_images: View of the patient's left upper arm prior to antifungal treatment showing cribriform ulceration.
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case_images: A 78-year-old male presented with a non-healing left arm ulcer in June 2017 (Figure 1).
case_images: Biopsy from November 2018. (a) Hematoxylin and eosin stain (magnification 400x) showing intra-histiocytic and extracellular yeasts measuring from 3 to 5 microns, resembling Histoplasma organisms. (b) Periodic acid-Schiff stain (magnification 400x) showing yeasts measuring 3-12 microns in diameter within histiocytes. (c) Grocott's methenamine silver stain (magnification 400x).
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case_images: A 4-mm punch biopsy of the ulcer edge showed numerous three- to four-micron intra-cytoplasmic yeasts within histiocytes (Figure 2(a)). Hundreds of intracellular organisms were PAS stain-positive and Grocott's methenamine silver stain-positive (Figure 2(b) and (c)), ranging from 3 to 12 microns with some budding yeasts.
case_images: View of the patient's left upper arm 3 months post-treatment.
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case_images: Treatment continued for 4 months leading to complete wound regression and healing of the left arm (Figure 3).
case_images: Biopsy from June 2017. (a) Hematoxylin and eosin stain from the biopsy showing suppurative dermatitis below an ulcer, in which focally a multinucleated histiocyte is visible (magnification 400x). (b) A single PAS-positive yeast organism measuring 4-6 microns found on re-examination (magnification 640x).
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