PHOTO QUIZ
Anthony Amoroso, Section Editor
A 43-Year-Old Brazilian Man With a Chronic Ulcerated Lesion
(See pages 314–5 for the Answer to the Photo Quiz.)
Figure 3. Skin biopsy section. A, Periodic acid-Schiff stain. B, GomoriGrocott methenamine silver stain (×1000 magnification).
Figure 1. Papular, infiltrated, and ulcerated 60 × 35-mm lesion on the
right forearm, with subcutaneous sporotrichoid nodules.
Figure 2. Skin biopsy: fresh direct microscopic examination (×1000
magnification).
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PHOTO QUIZ
A 43-year-old Brazilian man came to our hospital in Cayenne,
French Guiana, seeking dermatologic consultation for a chronic
ulcerated lesion that had been present on his right forearm for
18 months. The man had worked in the Amazon rainforest and
had a history of type 2 diabetes. Pyogenic infection was suspected, and the patient was initially treated with trimethoprimsulfamethoxazole. Cutaneous leishmaniasis was suspected due
to the patient’s forest activities and no evolution of the lesion.
A minor improvement of the lesion was observed after 5 injections of pentamidine isethionate. The patient returned to the
hospital 5 months after the last injection. The 60 × 35-mm singular lesion, located on the outer side of his right forearm, was
papular, infiltrated, and ulcerated (Figure 1). Subcutaneous
sporotrichoid nodules were found without satellite lymphadenopathy or systemic and otolaryngologic signs. A fresh direct
microscopic examination (Figure 2), a periodic acid-Schiff
stain, and a Gomori-Grocott methenamine silver stain were
performed on a skin biopsy specimen (Figure 3).
What is your diagnosis?
Clinical Infectious Diseases 2014;59(2):264
© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases
Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@
oup.com.
DOI: 10.1093/cid/ciu377
PHOTO QUIZ
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