Derm Pics: Fungal Infections

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Name and causative organism?

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Sporotrichosis
Caused by Sporothrix schenckii (dimorphic fungi)
Note: chain of suppurating (festering) lymphocutaneous nodules that are beginning to drain (post-separation of the amoeba)

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Test and indication

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Positive KOH stain for dermatophytes - note presence of hyphae at the arrow

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India ink stain of cryptococcus
note: encapsulated, spherical yeast, some are budding

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Geographic distribution of Blastomyces dermatitidis
Especially in SE, mississippi/ohio river valleys in southern portions, seaways of the lakes

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Blastomycoses caused pneumonia
note: lobar concentration of infiltrate

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blastomycosis
note: mimics malignancy

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blastomycosis
note: mimics malignancy

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Blastomycosis sputum - LCB mount
Note: Broad based budding yeast with thick refractile walls

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Blastomycoses dermatidis culture
Note: Broad based budding yeast with thick refractile walls

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Blastomycoses dermatidis
Note: Broad based budding yeast with thick refractile walls

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Geographical distribution of Histoplasma capsulatum
Especially Ohio and Mississippi river valleys

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Histoplasma capsulatum pneumonia
note: diffuse infiltrate - miliary looking

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Disseminated histoplasmosis
note: mucosal ulcers indicate dissemination (not common)

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This is bone marrow aspirate

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Histoplasma capsulatum
note: presence of yeasts in the macrophage is common in dissemination

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Histoplasma capsulatum silver stain
note: ovoid yeasts with narrow based budding

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Geographical distribution of coccidioidomycosis

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Cutaneous presentation of coccidioidomycosis as erythema nodosum

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coccidioidomycosis pneumonia
note: thin walled cavity without fluid in upper lobe

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coccidioidomycosis pneumonia
note distribution in right lower lobe with some surrounding infiltrate

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coccidioidomycosis as a yeast in tissue
note: spherule contains multiple yeast forms inside it

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coccidioidomycosis
note: characteristic spherule full of endospores on left - on right is baby spherule

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Candidiasis manifesting as fungemia on palate
note: the patches are hard to scrape off - bleeding left behind because slightly inflammatory

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Disseminated Candidiasis with blood borne seeding of the skin
note: lesions present as nodules or papules

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single organ specific candidiasis
note: hard white exudate in retina is disseminated candidiasis with fungal retinitis (will eventually become inflammatory and extend out into vitrous)

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what is the hyper-dense area

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Dissemination of candidiasis to the liver (single organ specific)

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Candidiasis in tissue as yeast and pseudo-hyphae
note: characteristic pseudo-hyphae are yeast forms that have started to elongated and the bud stays attached - suggested by the pinched in looking attachment

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Cryptococcosis pneumonia
Arrow points to discrete foci characteristic of disseminated cryptococcosis

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Cryptococcosis meningitis (primary presentation)
White patches are discrete foci characteristic of disseminated cryptococcosis

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disseminated cryptococcosis in HIV pt
note: molluscum-looking lesions - must biopsy to identify

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india ink preparation of CSF from patient with cryptococcosis meningitis

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cryptococcosis KOH prep shows encapsulated yeasts

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cryptococcosis - classic gram stain to demonstrate capsule

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Invasive Pulmonary Aspergillosis
note: pleural based infarct pattern

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Invasive Pulmonary Aspergillosis
note: nodular infiltrate with surrounding "halo sign" (hairlike projections around the nodule)

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Invasive aspergillosis - sinonasal disease
note: black area is necrosis from tissue infarction

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Invasive Pulmonary Aspergillosis
note: nodular infiltrate with surrounding "halo sign" (hairlike projections around the nodule)

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also, why does this sign occur

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Invasive Pulmonary Aspergillosis
note: "air crescent sign" = fungus ball/nodule in center and around it there is a crescent of air (infarcted lung area results in air in the cavity)

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Aspergillosis
note: "A" shaped - acute angle branching (less than 90 degrees), septated
*tissue histology alone is not diagnostic