case_images: PMC11380602_01
case_images: Clinical presentation of the patient and laboratory findings of the excisional specimen. (A) A 3.5x2 cm infiltrative reddish plaque with unclear boundaries and yellow-white crusts was observed on the back of right hand. (B) HE staining of biopsy tissue showed pseudoepitheliomatous hyperplasia in the epidermis and the infiltration of lymphocytes, neutrophils, histiocytes and multinucleated giant cells in the dermis (magnificationx100). The pseudoepitheliomatous hyperplasia in the epidermis was annotated by dashed boxes. The infiltration of lymphocytes, neutrophils, plasma cell and multinucleated giant cells in the dermis was annotated by yellow circle, solid box, arrow and triangle, respectively. (C) PAS staining of biopsy tissue showed the horizontal section of hyphae (red oval, magnification x400). (D) Fungal culture of biopsy specimen and purulent secretion revealed multiple, velvety, brown colonies on Sabouraud dextrose agar (SDA) for 14 days. (E) The microscopic characteristics of the isolate showed thin, branched, hyaline septate hyphae (magnification x400). (F) The total Sporothrix read number detected in biopsy tissue accounted for 34.7% of the total amount of reads. (G) The skin lesion was dramatically ameliorated after treatment with oral itraconazole 400mg/day for 2 months.
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case_images: PMC11380602_01_CCID-17-1981-g0001.jpg
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case_images: Purulent secretion and crusts were observed on the uneven surface of plaque (Figure 1A). Histopathological examination of biopsy tissue revealed pseudoepitheliomatous hyperplasia in the epidermis and the infiltration of lymphocytes, neutrophils, histiocytes and multinucleated giant cells in the dermis, using hematoxylin eosin (HE) staining (Figure 1B), suggestive of an infective granuloma. Fortunately, scattered round yeast cells were observed in the dermis by periodic acid-Schiff (PAS) staining (Figure 1C). Fungal culture of biopsy specimen and purulent secretion from the infection site both revealed multiple, velvety, white colonies on Sabouraud dextrose agar (SDA) for 7 days at 28 C. (Figure 1D). The microscopic characteristics of the isolate showed thin, branched, hyaline septate hyphae (Figure 1E). The total Sporothrix read number detected in biopsy tissue was 20005 reads, accounting for 34.7% of the total reads (Figure 1F). The cutaneous lesions were dramatically ameliorated (Figure 1G).