Dermatopathology

Streptococcal Infection Face

Final Diagnosis: Dermal abscess in association with rare gram positive diplococci as a morphologic variant of pneumococcal skin infection.

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Slide 1: The patient is a 19-year-old who presents with a swelling of the right cheek. It is a 3 x 2 cm lesion that is fluctuant. The working diagnosis is a fistulous tract.

Slide 2: The sample shows an extensive abscess cavity. The abscess is characterized by sheets of neutrophils, admixed with scavenger macrophages and plasma cells with resultant lysis of the connective tissue matrix.

Slide 3: The zone of neutrophilia is one that is quite circumscribed and therefore architecturally defines an abscess as opposed to the more diffuse pattern of neutrophilic dermolysis that one characteristically sees in pyoderma gangrenosum or cellulitis.

Slide 4: A Gram stain highlights a few very small gram-positive organisms confined to the zone of dermal neutrophilia.

Slide 5: A Gram stain highlights a few very small gram-positive organisms confined to the zone of dermal neutrophilia.