Print Email
 

Clinical Images

A Bump on the Cheek

Koh Okamotom, M.D., Smita Patel, MBBS, Patricia L. Demarais, M.D.

November 11, 2016

A 36- year-old healthy male presented with a 1-month history of a painless verrucoid nodule on his left zygoma (See Image 1). He reported that it started as a white spot, about 2-3 mm in size,  and enlarged rapidly. It was associated with purulent discharge, which did not improve despite empiric antimicrobial treatment. He was born and raised in Chicago. He worked as a music teacher. He reported running outside on occasions but denied prolonged sun exposure or trauma. He smoked 15 cigarettes a day for the past 15 years. He denied consuming alcohol or other illicit drug. He had no family history of skin cancer. Review of systems was negative, including fever or other systemic symptoms. Physical examination revealed a 2 cm by 2 cm raised red well demarcated lesion on his left zygoma covered with a blood crust. It was non tender. Purulent material was seen on pressure. He had no palpable lymphadenopathy. Reminder of examinations was unremarkable. Complete blood counts and a complete metabolic panel including liver function tests were within normal limits. A shave biopsy was performed and pathology showed broad-based budding yeast forms with associated neutrophilic infiltrate and pseudoepitheliomatous hyperplasia of the epidermis (See Image 2). 

Image-1.jpg

Image 1

Image-2.jpg

Image 2



Click here to view answer

References:
1.  Mason AR, Cortes GY, Cook J, Maize JC, Thiers BH. Cutaneous blastomycosis: a diagnostic challenge. Int J Dermatol. 2008;47(8):824-30.
2.  Chapman SW, Lin AC, Hendricks KA, Nolan RL, Currier MM, Morris KR, et al. Endemic blastomycosis in Mississippi: epidemiological and clinical studies. Semin Respir Infect. 1997;12(3):219-28.
3.  Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG, et al. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(12):1801-12.


Authors:
1. Koh Okamoto, M.D. is an infectious diseases fellow physician at Rush University Medical Center/ John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States. 

2. Smita Patel, MBBS is a pathology resident physician at Rush University Medical Center. 

3. Patricia L. Demarais, M.D. is an infectious diseases physician at John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States. She is an assistant professor at Rush Medical College. 





 

Submit content to JGIM

JGIM encourages submission of articles aimed at improving patient care, education, and research in primary care and general internal medicine in all settings. Submissions must be original and not currently under consideration for publication in another peer- reviewed medium (paper or electronic).

Learn How to Submit Here

 

FEATURED ARTICLE

 

Darlyn Victor, MD, Paul Moots, MD and Jacqueline Fischer, MD

October 13, 2016

A 39-year-old African-A....

Read Article
 

Most Viewed Articles

73 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
25 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF
31 Views

The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study.

O’Brien, Matthew J.; Whitaker, Robert C.

Read Article| Download PDF

Most Recent Web Only Content

November

13

Hypertriglyceridemia-induced Acute Pancreatitis

Faryal Nadeem, MD; Syed Shabbir, MD

Read Article

October

30

The Patient’s Wife

Teresa Lee, MD, PhD

Read Article

August

25

Diagnostic Schema

Denise M. Connor, Rabih Geha, Mark Henderson, Jeff Kohlwes

Read Article

April

26

A Prescription for Kindness

Bui, Simonetti, Benson, Malek and Anderson

Read Article