Blastomycosis | Dermatopathology

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

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Slide 1: 30 year-old woman presenting with cough, night sweats and numerous ulcerated nodules of bilateral arms. The epidermis is acanthotic with regenerative changes. Even from this magnification we can appreciate a dermal based inflammatory process with extension into the subcutaneous adipose tissue.

Slide 2: The biopsy shows superficial coalescing nodular foci of neutrophilic and granulomatous inflammation.

Slide 3: In the dermis there is neutrophil rich inflammatory infiltrate along with lymphocytes and histiocytes including multinucleated giant cells. Can you spot any organisms at this magnification?

$Slide 4: Multiple fungal forms are seen. The fungal forms are spherical with a thick refractile cell wall. They are multinucleate and have a broad based budding.$

$Slide 5: Multiple fungal forms are seen. The fungal forms are spherical with a thick refractile cell wall. They are multinucleate and have a broad based budding.$

Slide 7: Yeast forms exhibiting relatively symmetrical broad-based budding typical for and diagnostic of blastomycosis.

Slide 8: Yeast forms exhibiting relatively symmetrical broad-based budding typical for and diagnostic of blastomycosis.