ABSTRACT
Blastomycosis-like pyoderma is a rare cutaneous disease presenting as solitary or multiple verrucous or ulcerated plaques and nodules in a susceptible patient. The diagnostic criteria include characteristic verrucous plaques with pustules and elevated borders, histopathologic findings of pseudoepitheliomatous hyperplasia with abscesses, growth of at least one bacterium in tissue culture, and exclusion of other infectious sources. This report describes a case of a 62-year-old man with poorly controlled type 2 diabetes mellitus who presented with plaques, nodules, and ulcers in both groins and the right ankle. The patient was initially misdiagnosed with multiple squamous cell carcinomas and underwent several operations. A review of the pathology slides revealed pseudoepitheliomatous hyperplasia with multiple dermal abscesses, while repeated wound and tissue cultures were positive for coagulase-negative Staphylococcus. Blastomycosis-like pyoderma was diagnosed. The patient was subsequently treated with culture-guided prolonged antibiotic therapy followed by intralesional steroid injection, which led to gradual resolution of the lesions.
Subject(s)
Blastomycosis , Carcinoma, Squamous Cell , Diabetes Mellitus, Type 2 , Pyoderma , Skin Diseases , Male , Humans , Middle Aged , Blastomycosis/diagnosis , Hyperplasia , Abscess/diagnosis , Pyoderma/diagnosis , Pyoderma/pathology , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Skin Diseases/diagnosis , Diagnostic Errors , Diagnosis, DifferentialABSTRACT
Blastomycosis-like pyoderma is a form of pyoderma with variable clinical findings and histopathological features. We present a case series of 39 patients collected over a 35-year period to demonstrate its clinical features and histological findings. The most common clinical presentations found were solitary plaques, solitary nodules, sinuses, crypts, verrucous plaques and discharge, usually on sun-exposed skin. The most common histopathological findings were chronic granulomatous inflammation, suppurative inflammation, sinus and abscess formation, pseudoepitheliomatous hyperplasia, transepidermal elimination and scarring. We discuss its treatment and the recent literature that has focused on its response to acitretin.
Subject(s)
Pyoderma/diagnosis , Pyoderma/pathology , Adult , Aged , Aged, 80 and over , Blastomycosis/pathology , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
Blastomycosis-like pyoderma is a rare, cutaneous bacterial infection of skin, seen in malnourished individuals, in a poor state of health and manifests as vegetating skin lesions. It is an unusual tissue reaction possibly to bacterial infection, the most common organism being Staphylococcus aureus. This case report is of a 35-year-old male who presented with thick verrucous surfaced plaques and papules on trunk and extremities since 2 months. Investigations revealed anaemia with hypochromasia, neutrophilic leucocytosis, hypo-proteinemia and hypo-albuminemia with reversal of A/G ratio. Pathergy test was negative. Pus on Gram's stain showed plenty of pus cells, and negative for AFB and fungal stain. On culture of pus grew Coagulase negative staphylococcus species. Biopsy showed acanthosis of epidermis with moderate lymphocytic infiltrates in dermis and focally a few neutrophils and histiocytes. Patient fulfilled the criteria for diagnosis of blastomycosis like pyoderma viz., presentation of large verrucous plaques with pustules and ulcers with elevated border, histologically neutrophilic infiltration and growth of one pathogenic bacterium on culture. Patient responded to long-term cefotaxime therapy.
ABSTRACT
Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Granuloma Inguinale/drug therapy , Lymphogranuloma Venereum/drug therapy , Mycoses/drug therapy , Acitretin/therapeutic use , Amphotericin B/therapeutic use , Azoles/therapeutic use , Blastomycosis/diagnosis , Blastomycosis/drug therapy , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Dermatomycoses/diagnosis , Doxycycline/therapeutic use , Granuloma Inguinale/diagnosis , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Humans , Keratolytic Agents/therapeutic use , Lymphogranuloma Venereum/diagnosis , Mycoses/diagnosis , Pyoderma/diagnosis , Pyoderma/drug therapy , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/drug therapy , Sporotrichosis/diagnosis , Sporotrichosis/drug therapyABSTRACT
Blastomycosis-like pyoderma is a rare, vegetating skin lesion that is an unusual exaggerated tissue reaction possibly to prolonged primary or secondary bacterial infection. We report a case of blastomycosis-like pyoderma in a man with Down syndrome, diabetes mellitus and hypothyroidism who responsed poorly to conventional therapies, including antibiotics and correction of predisposing factors for a long time, but experienced dramatic improvement after 3 months of acitretin treatment.
ABSTRACT
Blastomycosis-like pyoderma is a rare, vegetating skin lesion that is an unusual exaggerated tissue reaction possibly to prolonged primary or secondary bacterial infection. We report a case of blastomycosis-like pyoderma in a man with Down syndrome, diabetes mellitus and hypothyroidism who responsed poorly to conventional therapies, including antibiotics and correction of predisposing factors for a long time, but experienced dramatic improvement after 3 months of acitretin treatment.
Subject(s)
Acitretin , Anti-Bacterial Agents , Bacterial Infections , Diabetes Mellitus , Down Syndrome , Hypothyroidism , Pyoderma , SkinABSTRACT
Blastomycosis-like pyoderma is an uncommon vegetating tissue reaction, often secondary to a bacterial infection occurring in patients with a compromised immune system. We describe a clinically blastomycosis-like pyoderma on the right ankle and knee in a patient with iatrogenic Cushing syndrome, hypertension, hypercholesterolemia and congestive heart failure.
Subject(s)
Humans , Ankle , Bacterial Infections , Cushing Syndrome , Heart Failure , Hypercholesterolemia , Hypertension , Immune System , Knee , PyodermaABSTRACT
Blastomycosis-like pyoderma is a rare reaction pattern to a superficial bacterial infection in persons with a variety of underlying coniditions, including inflammatory and neoplastic pathologic conditions, and in associaton with a primary immunodeficiency state. We describe a clinically recurrent blastomycosis-like pyoderma on the right ankle area in an otherwise healthy man.
