Case #234 – August, 2008

A 29 year-old man with travel history to Costa Rica, Belize, and Nicaragua developed an ulcerative lesion on his right foot. The lesion did not respond to over-the-counter medications so the patient went to his health care provider. He was referred to an infectious disease specialist due to his travel history. A biopsy was performed near the edge of the lesion and the tissue specimen was sent to a reference laboratory for testing. The tissue specimen was divided into two parts, one of which was used to inoculate a NNN slant for culture. The other part was used to prepare a touch-prep smear, which in turn was fixed with methanol and then stained with Giemsa. Figures A and B show what was observed on that smear. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.

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