case_images: PMC4347385_01
case_images: A and B, Patient with an erythematous mass with central ulceration, purulent discharge, adherent to deep tissues, producing partial obstruction of the left eye visual field, and complete obliteration of the left nostril. C, Histologic samples from the patient showing groups of large vacuolated histiocytes containing gram-negative bacteria (Mikulicz cells), many of which had Russell bodies (eosinophilic, homogenous inclusions found in a plasma cell undergoing excessive synthesis of immunoglobulin; haematoxylin and eosin 400x) (arrows). D, Patient after treatment at the recent follow-up before he was scheduled for a definitive nasal reconstruction.
case_images: tropmed-92-3-g001d.jpg
case_images: PMC4347385_01_tropmed-92-3-g001d.jpg
case_images: F1
case_images: At physical examination, he had an erythematous mass with central ulceration, purulent discharge, adherent to deep tissues, producing partial obstruction of the left eye visual field, and complete obliteration of the left nostril (Figure 1A and B). Histologic samples from the mass and borders ruled out malignancy, but showed groups of large vacuolated histiocytes containing gram-negative bacteria (Mikulicz cells), many of which had Russell bodies (eosinophilic, homogenous inclusions found in a plasma cell undergoing excessive synthesis of immunoglobulin arrows (Figure 1C). At the most recent follow-up, there were no signs of relapse of infection, and the patient was scheduled for a definitive nasal reconstruction (Figure 1D).