The findings are diagnostic of blastomycosis. There is a fairly robust neutrophilic and granulomatous response in association with the fungal elements. Given the history of cough along with the dermal localization of the fungus without any epidermal continuity the findings would be compatible with hematogenously disseminated blastomycosis

Weill Cornell Medicine Dermatopathology 1300 York Avenue
Room F-309
Box #58
New York, NY 10065 Phone: (212) 746-6434