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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). 



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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.