Medical Images
A Red, Swollen Finger
A 75-year-old man with atrial fibrillation taking amiodarone and apixaban, heart failure with an ejection fraction of 20%, and long QT interval presented for evaluation of progressive swelling and erythema of the right fifth finger over 5 months. He had no known trauma to the hand or unusual exposures. He owned a cat and enjoyed the outdoors. On examination, he had a small nodular papule on the right fifth digit with surrounding fusiform swelling and erythema (Figure 1). The left hand was unaffected.The Blastomycosis Bluff by Purpureocillium lilacinum
A 73-year-old patient with a history of rheumatoid arthritis and inclusion body myositis on long-term prednisone and azathioprine presented with a 3-month history of tender erythematous nodules on his right lower extremity (Figure 1). A skin biopsy revealed yeast forms with broad-based budding yeast (Figure 2, [arrow]). Initially, a diagnosis of cutaneous blastomycosis was made, and he was initiated on itraconazole. However, (1-3)-β-d-glucan assay was elevated at >500 pg/mL (reference range: <80 pg/mL), and biopsy culture was returned 11 days later growing a violet-colored colony (Figure 3) identified as Purpureocillium lilacinum under microscopy, with phialides with swollen bases and pigmented and rough-walled conidiophore stipes (Figure 4).Kaposi Sarcoma Masquerading as a Tooth Abscess in a Patient With Human Immunodeficiency Virus
A 36-year-old male patient newly diagnosed as having human immunodeficiency virus/acquired immunodeficiency syndrome with a CD4 count on presentation of 3 cells/μL presented with an oral lesion. This lesion was previously thought to be a dental abscess that persisted despite incision and drainage (Figure). The lesion had a raised nodular appearance, was purple, and seemed to be of vascular origin. This was highly suspicious for Kaposi sarcoma. This suspicion was confirmed by a biopsy showing tumor cells positive for CD31 and human herpesvirus 8.
