case_images: PMC4793953_01
case_images: - Erythematous papule with a central umbilication in the left nasal wing,
  shallow ulcerated lesions on the palate and Aguiar Pupo stomatitis
case_images: 0036-4665-rimtsp-S1678-9946201658012-gf01.jpg
case_images: PMC4793953_01_0036-4665-rimtsp-S1678-9946201658012-gf01.jpg
case_images: f01
case_images: Physical examination showed good general conditions, there was no palpable lymphadenopathy; dermatological examination revealed shallow ulcerated lesions on the palate surrounded by erythema, measuring about 8 mm; multiple mulberry-like erythematous eroded papules giving to the lesion a cobblestone appearance (Aguiar-Pupo stomatitis); erythematous papule with a central umbilication of about 3 mm located at the left nasal wing (Fig. 1); and an infiltrated erythematous plaque with irregular borders and indistinct boundaries, of approximately 1 cm in diameter, located on the left flank (Fig. 2).
case_images: - A and B - Chronic granulomatous process with pseudoepitheliomatous
  hyperplasia and ulceration with numerous fungal cells (H&E X40); C -
  numerous oval / round cells with multiple budding, like a "pilot wheel" cell
  (Groccot X40)
case_images: 0036-4665-rimtsp-S1678-9946201658012-gf03.jpg
case_images: PMC4793953_01_0036-4665-rimtsp-S1678-9946201658012-gf03.jpg
case_images: f03
case_images: Biopsies in the described mucocutaneous lesions were performed, including oral ulcers, which were consistent with this diagnosis (Fig. 3).
case_images: - Bilateral nodular infiltrates, excavated area with suggestive area of
  necrosis in the middle third of the right lung and bilateral pleural
  effusion
case_images: 0036-4665-rimtsp-S1678-9946201658012-gf04.jpg
case_images: PMC4793953_01_0036-4665-rimtsp-S1678-9946201658012-gf04.jpg
case_images: f04
case_images: The basal serum cortisol was normal and abdominal CT scan showed no specific changes; however, in lung CT (Fig. 4) an extensive involvement with bilateral nodular infiltrates, an excavated area suggestive of necrosis in the middle third of the right lung, and bilateral pleural effusion, largest in the right lung, were seen.