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Am J Trop Med Hyg. 2010 June; 82(6): 979.
PMCID: PMC2877435

Ulcer over Chin in an Immunocompromised Individual

A 45-year-old human immunodeficiency virus (HIV)-positive male from northeastern India presented with fever and cough as well as a 3-month-old ulcer over the chin. On examination, there was a 5 × 5-cm superficial ulcer with a thick adherent crust over the chin (Figure 1). The individual had three papules with central umbilication over the neck and face. He had anemia (hemoglobin = 7.5 g) and a cluster of differentiation 4 (CD4) count of 89 cells/μL. His chest radiograph and computed tomography (CT) scan of the thorax showed right mid- and lower-zone consolidation. Histopathology of the umbilicated papule and the ulcer showed numerous yeast forms and a few sausage-shaped structures with central septation within the histiocytes (Figure 2). Fungal tissue cultures from skin lesions and bronchoalveolar lavage aspirates showed a greenish yellow, flat, velvety wrinkled colony with surrounding diffusible red pigment (Figure 3). This was diagnostic of Penicillium marneffei infection. Sputum smears and culture were negative for tuberculosis. Direct immunofluorescence detection for Pneumocystis carinii from sputum sample was negative.

Figure 1.
Superficial ulcer with adherent crusts over the chin. This figure appears in color at www.ajtmh.org.
Figure 2.
Yeast and sausage shaped structure with central septation, PASD 400×. This figure appears in color at www.ajtmh.org.
Figure 3.
Greenish yellow, flat, velvety colony with surrounding diffusible red pigmentation. This figure appears in color at www.ajtmh.org.

Mucocutaneous lesions are seen in two-thirds of patients with Penicillium marneffei infection. These include generalized papular eruptions, central umbilicated papules resembling molluscum contagiosum, acne-like lesions, folliculitis, subcutaneous nodules, necrotic nodules, papules and nodules with ulceration, oropharyngeal papules, palatal perforation, and genital papules.1

Footnotes

Authors' addresses: Dincy Peter, Department of Dermatology, Christian Medical College, Vellore - 632004, Tamil Nadu, India, E-mail: moc.liamg@retepycnid. Meera Thomas, Department of Pathology, Christian Medical College, Vellore - 632004, Tamil Nadu, India, E-mail: moc.liamtoh@areem_mot. Mary Mathews, Department of Microbiology, Christian Medical College, Vellore - 632004, Tamil Nadu, India, E-mail: ni.ca.erollevcmc@swehtamm.

References

1. Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirasthana T. Disseminated Penicillium marneffei infection in Southeast Asia. Lancet. 1994;344:110–113. [PubMed]

Articles from The American Journal of Tropical Medicine and Hygiene are provided here courtesy of The American Society of Tropical Medicine and Hygiene