Case #297 – April, 2011

A 34-year-old man presented to his health care provider with a lesion with a dark center on his right hallux (big toe) that was inflamed and painful. Travel history included Panama and Ecuador one month prior. During the examination, the physician collected fluid that was exuding from the center of the lesion. The exudate was examined microscopically; Figures AC shows what was observed at 20x, 40x, and 100x, respectively. The objects of interest measured on average 600 micrometers. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

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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