Clinicopathologic spectrum of specific cutaneous lesions of disseminated coccidioidomycosis.

BACKGROUND

Disseminated coccidioidomycosis merits greater attention because the number of persons living and traveling in endemic areas is increasing.

OBJECTIVE

Our purpose was to study the clinical and histopathologic findings in patients with specific cutaneous disseminated coccidioidomycosis.

METHODS

In six patients with specific skin lesions of disseminated coccidioidomycosis, the diagnosis was confirmed by identification of the organism in tissue or by positive results of tissue culturing.

RESULTS

Clinical lesions included solitary granulomatous plaques in two patients and multiple papular, nodular, or pustular lesions in four patients, two of whom also had subcutaneous abscesses. Identifying organisms directly in tissue was possible in only 8 of 17 biopsy specimens and in five of six patients. The histopathologic features showed various degrees of three primary patterns: (1) abscess formation with necrosis, (2) epithelial hyperplasia and granuloma formation with microabscesses, and (3) vascular and perivascular proliferative and inflammatory cell reactions at times suggesting vasculitis. Tissue eosinophilia, present in all patients, was striking in two (eosinophilic abscess formation) and notable in another (vascular inflammation with eosinophilia).

CONCLUSION

Cutaneous manifestations of disseminated coccidioidomycosis may be more common and varied than usually recognized.