Case #250 – April, 2009

A 45-year-old man developed a few ulcerative lesions on his left forearm about one month after returning from a nature excursion in Costa Rica. He was referred to an infectious disease specialist by his primary care provider. A biopsy was obtained from the rim of one of the lesions, and subsequently sectioned and stained with hematoxylin and eosin (H&E). Figures A and B show what was observed on one of the slides. What is your diagnosis? Based on what criteria? What other testing would you recommend?

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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