Case #20:

Clinical Presentation:
34 year old HIV infected man from Ecuador developed an ulcerating papule on the right side of his face.

Clinical Diagnoses:
Viral lesion: Herpes Simplex
Fungal Lesion: Histoplasma, Cryptococcus
Syphilitic Gumma
Skin Cancer: Basal Cell Carcinoma

Case 20 Image 2: Skin Biopsy

Discussion:
Microbiologic Diagnosis:
Paracoccidiomycosis
This dimorphic fungus is endemic in rural Latin America. Infection occurs by inhaling mold spores from soil. In tissue, the fungus is recognized by its characteristic thick-walled yeast with MULTIPLE BUDS. This form is sometimes called the “Captain’s Wheel.” Infected persons may develop pulmonary lesions, skin lesions, mucous membrane lesions or dissemination to many organs.