Extract

(See pages 314–5 for the Answer to the Photo Quiz.)

A 43-year-old Brazilian man came to our hospital in Cayenne, French Guiana, seeking dermatologic consultation for a chronic ulcerated lesion that had been present on his right forearm for 18 months. The man had worked in the Amazon rainforest and had a history of type 2 diabetes. Pyogenic infection was suspected, and the patient was initially treated with trimethoprim-sulfamethoxazole. Cutaneous leishmaniasis was suspected due to the patient's forest activities and no evolution of the lesion. A minor improvement of the lesion was observed after 5 injections of pentamidine isethionate. The patient returned to the hospital 5 months after the last injection. The 60 × 35-mm singular lesion, located on the outer side of his right forearm, was papular, infiltrated, and ulcerated (Figure 1). Subcutaneous sporotrichoid nodules were found without satellite lymphadenopathy or systemic and otolaryngologic signs. A fresh direct microscopic examination (Figure 2), a periodic acid-Schiff stain, and a Gomori-Grocott methenamine silver stain were performed on a skin biopsy specimen (Figure 3).

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