A 66-year-old male patient was referred to the dermatology department at our hospital in June 2013 for a single cutaneous lesion located in the back of his left leg. Recent empirical treatment with oral and topical antibiotics had been ineffective. On examination, the lesion (1 cm in diameter), which had evolved since December 2012, appeared nodular, inflammatory, and ulcerating but was painless and nonpruritic (Fig. 1, left). No other lesion was observed. The patient was in good general condition, had no fever, and had no significant medical history. He reported a 2-week travel to Thailand in November 2012. Histopathological examination of a skin biopsy specimen evidenced several granulomas and giant cells in the dermis, along with some melanized elements (5 to 10 μm in diameter), highlighted in Fig. 1, right panel.
FIG 1.
(Left) Cutaneous lesion involving the back of the left leg; (right) histopathological examination of the skin biopsy specimen (periodic acid-Schiff staining; magnification, ×400).
(For answer and discussion, see page 1409 in this issue [doi:10.1128/JCM.01250-14].)