Granuloma gluteale infantum: case report and review of the literature.

Granuloma gluteale infantum, a benign granulomatous eruption involving the gluteal region, histologically shows a nonspecific dermal inflammatory infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and eosinophils. It is important to recognize this condition, as it may clinically simulate a neoplastic process. It arises as a complication of primary irritant diaper dermatitis, however, and typically resolves without treatment.

Phaeohyphomycotic cyst caused by a recently described species, Phaeoannellomyces elegans.

An 81-year-old man presented with a chronic, painful nodule on the palmar surface of the left fourth finger. As a former farm worker, the patient acknowledged frequent soil-contaminated wounds of the left hand 4 to 12 years previously, but he denied any recent trauma. The patient's other medical problems included a history of chronic immunoglobulin A gammopathy and a new pleural mass eroding into adjacent ribs on chest X-ray. The finger nodule was excised and consisted of an intact phaeohyphomycotic cyst which yielded growth of a darkly pigmented fungus. At 25 degrees C, the isolate formed annellidic yeast cells having dark-brown walls consistent with the recently described species Phaeoannellomyces elegans. In vitro antifungal susceptibility tests indicated resistance to amphotericin B and variable susceptibility to imidazoles. The lesion was excised, and the patient received no antifungal therapy. After 9 months of follow-up, the fungal infection shows no signs of recurrence.

Light and electron microscopic observations of blastomyces dermatitidis in sputum.

Freshly expectorated sputum from a 52-year-old man with extensive pulmonary blastomycosis was examined by light and electron microscopy. Wet preparations of the sputum, stained with 1% aqueous cresyl violet, revealed numerous thick-walled, spherical blastospores and occasional budding forms. Ultrastructurally, the blastospores revealed a double-layered cell wall, the peripheral portion of which consisted of a thick, densely staining lamellar material of variable thickness, suggestive of the glycocalyx of bacterial cells. Mitochrondria and other organelles were easily recognized, but distinct nuclei were not observed. Retraction of the cell membrane and cytoplasmic mass from the cell wall was a common finding. Results of this case study suggest that electron microscopy of sputum may serve as an important adjunct to conventional staining techniques for the presumptive diagnosis of blastomycosis. Similar studies of other fungi in respiratory tract secretions may be helpful in providing more precise morphologic identification.