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Presented by Ralph Hruban, M.D. and prepared by Andrea Subhawong, M.D.
Case 1: This gardener developed multiple subcutaneous nodules on her forearms.
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1. Question
Week 391: Case 1
This gardener developed multiple subcutaneous nodules on her forearms.images/5.4.09.01a.jpg
Correct
Answer: Sporotrichosis
Histology: A biopsy of one of the skin nodules revealed a mixed inflammatory cell infiltrate with acute inflammation and focal granulomatous inflammation. Small bodies with an eosinophilic star-burst pattern are present.
Discussion: Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. The organism is found in the soil and it can be traumatically implanted in the skin and subcutaneous tissue. It should not be surprising that gardening is a risk factor! Patients often report a history of being stuck by a thorny bush while gardening. Clinically patients present with subcutaneous nodules. These nodules may ulcerate and discharge pus. In most cases the infection is limited to the skin.
Microscopically, as illustrated in this case, the lesions contain a mixed inflammatory cell infiltrate, composed of acute inflammation and granulomatous inflammation. The organism is spherical to cigar-shaped, and ~ 3 µm in diameter. As shown in this case, the organisms are often surrounded by eosinophilic stellate material (the so called Splendore-Hoeppli phenomenon). A GMS or other fungal stain can be used to demonstrate the organism, and fungal culture may be required to establish the diagnosis.
Incorrect
Answer: Sporotrichosis
Histology: A biopsy of one of the skin nodules revealed a mixed inflammatory cell infiltrate with acute inflammation and focal granulomatous inflammation. Small bodies with an eosinophilic star-burst pattern are present.
Discussion: Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. The organism is found in the soil and it can be traumatically implanted in the skin and subcutaneous tissue. It should not be surprising that gardening is a risk factor! Patients often report a history of being stuck by a thorny bush while gardening. Clinically patients present with subcutaneous nodules. These nodules may ulcerate and discharge pus. In most cases the infection is limited to the skin.
Microscopically, as illustrated in this case, the lesions contain a mixed inflammatory cell infiltrate, composed of acute inflammation and granulomatous inflammation. The organism is spherical to cigar-shaped, and ~ 3 µm in diameter. As shown in this case, the organisms are often surrounded by eosinophilic stellate material (the so called Splendore-Hoeppli phenomenon). A GMS or other fungal stain can be used to demonstrate the organism, and fungal culture may be required to establish the diagnosis.
