UPMC
Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
5230 Centre Avenue
(412) 864-3860 Pittsburgh,
PA 15213 (412) 864-3890 FAX
Christina Wahlgren, MD, Grace Lee, MD and Jukic Drazen, MD
JANUARY 2008
CASE OF THE MONTH
CLINICAL FINDINGS
Clinical History
A 35 year old Caucasian male presented to clinic with a two week history of a tender nodule on his left upper back. The nodule developed three weeks prior to presentation after returning from a trip to Belize with his wife. The patient reported a small amount of blood tinged discharge from the lesion, but denied fever, chills, muscle aches or general malaise. The patient was seen by his primary care doctor who treated him with a ten day course of antibiotics without improvement in his symptoms. The patient’s wife had noted a similar lesion on her right upper arm.
Physical exam
revealed a tender 1.5 cm erythematous, indurated nodule with a central punctum draining serosanginous fluid on the left upper back.
Histopathology
Gross examination revealed a 1.2cm x 0.3cm x 1.0 cm piece of tan tissue with an oval opening measuring 0.2cm x 0.1cm surrounded by a brown pigmented ring. On sectioning, the subcutaneous tissue showed a blind ending furrow measuring 0.5cm in length and 0.2 cm in diameter. A second piece of tissue consisted of an intact pale tan larva with concentric black dotted rings measuring 0.6cm x 0.3 cm x 0.3 cm (Images 1 & 2).
On microscopic evaluation, a superficial and deep lymphohistiocytic infiltrate with numerous eosinophils was present accompanied by panniculitis (Images 3 & 4). The overlying epidermis was spongiotic and showed acanthosis with neutrophilic and eosinophilic infiltrate. In the deeper dermis, areas of necrosis surrounded by an inflammatory infiltrate were noted. PAS-D histochemical stain failed to reveal fungal microorganisms.
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