of the Right Cheek and Submandibular Areas
Nonhealing Masses Linda J.
REPORT OF A CASE
Deloach-Banta, MD, Francis A. Barber, MD, Naval Hospital, San Diego, Calif blood cell count, showed normal findings. The test for human immunodeficiency virus was negative. The patient's history was significant; in March 1988, it was noted that he had an abscess lateral to tooth 31 with associated tender cervical lymph nodes. He had undergone periodontal scaling with a root canal procedure, and he received penicillin (250 mg orally four times a day) for 10 days. In April 1988, skin nodules developed in the right cheek and submandibular areas. These masses persisted and intermittently drained sero-
sanguineous fluid. An excisional biopsy was performed in May 1988; the findings from the biopsy specimen revealed nonspecific histopathologic findings and negative cultures for coccidioidomycosis, histoplasmosis, and tuberculosis. In January 1989, the skin nodules recurred with intermittent drainage. His medical history also revealed smoking (40 pack-years). A review of his systems was otherwise noncontributory. The patient underwent excisional biopsy of the masses. Osseous débridement with biopsy specimens taken ofthe right mandible was also performed. Tissue was sent for routine and histopathologic examination and special stains w-ere done (Figs 4 through 6). Cultures were nondiagnostic.
Figure 1.
Figure 3.
Figure 5.
Figure 2.
Figure 4.
Figure 6.
In March 1989, a 49-year-old man presented with a 1-year history of nonhealing, mildly tender masses of his right cheek and submandibular area. The physical examination, except for that of the head and neck, showed normal findings. A 2-cm firm, mobile mass was observed over the right buccinator muscle; a similar mass was also seen in the right submandibu-
lar area (Figs 1 and 2). The roentgenograms from 1988 were reviewed (Fig 3). Laboratory studies, including complete
Chromomycosis
on
the Nose
David J. Gross, MD, Robert H. Schosser, MD John L. McClellan Veterans Affairs Hospital, Little Rock, Ark
REPORT OF A CASE In November 1988, a 52-year-old white man noted the onset of
the bridge of his nose. He had a history of nickel; therefore, he assumed that the metal bridge section of his glasses contained nickel and he bought a pair of plastic-framed glasses. Because the eruption persisted, he sought medical attention and presented to the dermatology clinic in early April 1989. It was learned that he was employed as a grounds attendant at a
an indurated area on
allergic
contact dermatitis to
(Figs 1 and 2). The remainder of his examination showed unremarkable findings. The findings from his serologic examinations were normal; the histopathologic examination revealed severe pseudoepitheliomatous hyperplasia and a severe chronic inflammatory and granulomatous reaction with multinucleated giant cells and intraepidermal microabscesses (Fig 3). Many sclerotic bodies were observed within the microabscesses and in nearby giant cells (Fig 4). What is your diagnosis?
resort area.
The patient's physical examination revealed a verrucous plaque with overlying crust involving the bridge of his nose
Figure 2. Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 06/20/2015 Figure 1.
Figure 3.
Figure 4.
Nonhealing Masses Linda J.
REPORT OF A CASE
Deloach-Banta, MD, Francis A. Barber, MD, Naval Hospital, San Diego, Calif blood cell count, showed normal findings. The test for human immunodeficiency virus was negative. The patient's history was significant; in March 1988, it was noted that he had an abscess lateral to tooth 31 with associated tender cervical lymph nodes. He had undergone periodontal scaling with a root canal procedure, and he received penicillin (250 mg orally four times a day) for 10 days. In April 1988, skin nodules developed in the right cheek and submandibular areas. These masses persisted and intermittently drained sero-
sanguineous fluid. An excisional biopsy was performed in May 1988; the findings from the biopsy specimen revealed nonspecific histopathologic findings and negative cultures for coccidioidomycosis, histoplasmosis, and tuberculosis. In January 1989, the skin nodules recurred with intermittent drainage. His medical history also revealed smoking (40 pack-years). A review of his systems was otherwise noncontributory. The patient underwent excisional biopsy of the masses. Osseous débridement with biopsy specimens taken ofthe right mandible was also performed. Tissue was sent for routine and histopathologic examination and special stains w-ere done (Figs 4 through 6). Cultures were nondiagnostic.
Figure 1.
Figure 3.
Figure 5.
Figure 2.
Figure 4.
Figure 6.
In March 1989, a 49-year-old man presented with a 1-year history of nonhealing, mildly tender masses of his right cheek and submandibular area. The physical examination, except for that of the head and neck, showed normal findings. A 2-cm firm, mobile mass was observed over the right buccinator muscle; a similar mass was also seen in the right submandibu-
lar area (Figs 1 and 2). The roentgenograms from 1988 were reviewed (Fig 3). Laboratory studies, including complete
Chromomycosis
on
the Nose
David J. Gross, MD, Robert H. Schosser, MD John L. McClellan Veterans Affairs Hospital, Little Rock, Ark
REPORT OF A CASE In November 1988, a 52-year-old white man noted the onset of
the bridge of his nose. He had a history of nickel; therefore, he assumed that the metal bridge section of his glasses contained nickel and he bought a pair of plastic-framed glasses. Because the eruption persisted, he sought medical attention and presented to the dermatology clinic in early April 1989. It was learned that he was employed as a grounds attendant at a
an indurated area on
allergic
contact dermatitis to
(Figs 1 and 2). The remainder of his examination showed unremarkable findings. The findings from his serologic examinations were normal; the histopathologic examination revealed severe pseudoepitheliomatous hyperplasia and a severe chronic inflammatory and granulomatous reaction with multinucleated giant cells and intraepidermal microabscesses (Fig 3). Many sclerotic bodies were observed within the microabscesses and in nearby giant cells (Fig 4). What is your diagnosis?
resort area.
The patient's physical examination revealed a verrucous plaque with overlying crust involving the bridge of his nose
Figure 2. Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 06/20/2015 Figure 1.
Figure 3.
Figure 4.
