case_images: PMC10931868_01
case_images: (a) Multiple hyperpigmented indurated nodules in a background of remarkably swollen left thigh and knee (b) Puncture of a nodule resulted in extrusion of serosanguinous discharge (c) A central erythema surrounded by a palisade of radial white lines indicating fibrosis on dermoscopy (d) A hyperpigmented nodule with central erosion and minimal scaling (e) An erosion and variable-sized white globules (arrows) surrounded by an interrupted fringe of white scales with a peripheral palisade of radiating white lines indicative of fibrosis (stars) on dermoscopy
case_images: JFMPC-13-372-g001.jpg
case_images: PMC10931868_01_JFMPC-13-372-g001.jpg
case_images: jfmpc_778_23-f001
case_images: There were multiple hyperpigmented, indurated nodules over the left thigh and knee [Figure 1a]. Two types of lesions were identified: The first exhibited central erythema surrounded by a palisade of radial white lines indicating fibrosis [Figure 1b and c] and the second revealed a central zone exhibiting an erosion and variable-sized white globules surrounded by an interrupted fringe of white scales with a peripheral palisade of radiating white lines indicative of fibrosis [Figure 1d and e]. Lesional puncture resulted in extrusion of either serosanguinous discharge [Figure 1b] or numerous white grains dispersed in purulent exudate [Figure 2a].
case_images: (a) Numerous yellowish grains within purulent discharge (b) A Gram-stained smear showing Gram-positive filamentous bacteria (c) Grains within an area of suppurative granulomatous dermatitis on H and E
case_images: JFMPC-13-372-g002.jpg
case_images: PMC10931868_01_JFMPC-13-372-g002.jpg
case_images: jfmpc_778_23-f002
case_images: Lesional puncture resulted in extrusion of either serosanguinous discharge [Figure 1b] or numerous white grains dispersed in purulent exudate [Figure 2a]. Grocott methenamine silver (GMS) stains. Gram-stained smears demonstrated Gram-positive filamentous bacteria [Figure 2b]. Histopathologic sections showed grains within an area of suppurative granulomatous dermatitis on H&E [Figure 2c], but no positivity to PAS or GMS.