Figure 2: Histologic appearance of the skin lesion, HIE stain x 200
Figure 1: Gross appearance of skin lesion
Figure 3: Periodic-acid-Schiff Stain of the resected skin lesion, magnification x 400, shows budding yeast (see arrow)
Figure 4: Pas stain at 1000 shows the double-contoured wall of the yeast
body detection by complement fixation, immuno-diffusion, and enzyme immunoassay (EIA) has also been described, but the diagnostic yield of these methods are not high. 5 In cases with cutaneous involvement, skin biopsy with histo- logical hematoxylin and eosin (H&E) and silver staining may reveal the organism, although the skin biopsy may not be diagnostic (i.e. current case). The histological changes without the visualization of the organism may prompt an
erroneous diagnosis of squamous cell carcinoma or kerato- acanthoma. 6 Oral antifungal agents, i.e. Itraconazole, have become the standard of care for cutaneous or pulmonary non-life threatening blastomycosis infections; the same is true with using Amphotericin-B for disseminated or life threatening diseases (ARDS) or in patients with immuno- suppression.
J La State Med Soc VOL 166 November/December 2014 249
Made with FlippingBook - Online catalogs