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Year : 2012  |  Volume : 3  |  Issue : 3  |  Page : 228-229  

SkIndia Quiz 7 - Giant erythematous plaque on the arm of an elderly woman

Department of Dermatology, Alshifa Hospital, Perinthalmanna, Kerala, India

Date of Web Publication29-Sep-2012

Correspondence Address:
K T Ashique
Karalikkattil House, Karakkaparamba, Vaniyambalam Post, Malappuram Dt.- 679339, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5178.96771

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How to cite this article:
Ashique K T. SkIndia Quiz 7 - Giant erythematous plaque on the arm of an elderly woman. Indian Dermatol Online J 2012;3:228-9

How to cite this URL:
Ashique K T. SkIndia Quiz 7 - Giant erythematous plaque on the arm of an elderly woman. Indian Dermatol Online J [serial online] 2012 [cited 2021 Jul 27];3:228-9. Available from: https://www.idoj.in/text.asp?2012/3/3/228/96771

A 55-year-old lady presented with an asymptomatic, gradually expanding patch over her left arm of over 5 years duration. She had occasional itching over the patch but offered no systemic complaints. Several years ago while handling firewood, a thorn had pricked her at the same site. Topical betamethasone and salicylic acid ointment applications would flatten the plaque temporarily with rebound upon stoppage. Various antifungal medications were also prescribed without relief.

On examination, the patient had a giant plaque over the posterior aspect of left arm measuring 10 × 5 cm with central clearing, crusting, and erythema on the periphery and an indurated margin [Figure 1]. The plaque was non-tender and sensations were intact. There was no similar or significant cutaneous finding elsewhere on her body. There was no regional lymphadenopathy. Except for an elevated ESR of 70 mm/h, baseline blood investigations and chest radiograph were normal. Mantoux test and KOH mount for fungus were negative. Histopathology revealed hyperkeratosis, irregular acanthosis, intra- and sub epidermal microabscesses, and small granulomas in the upper dermis composed of macrophages, epithelioid cells, and multinucleated giant cells [Figure 2] and [Figure 3].
Figure 1: Giant erythematous plaque with central clearing over the posterior aspect of the left arm with crusting and erythema on the periphery and indurated border

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Figure 2: Intraepidermal and subepidermal microabscesses with macrophages, epithelioid cells, and multinucleate giant cells (H and E, ×40)

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Figure 3: "Copper pennies" or Medlar bodies - fungal spores appearing as dark brown, thick walled, spherical bodies lying in a cluster of three at the centre (H and E, ×100)

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   What is the Diagnosis? Top

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   References Top

1.Bayerl C, Fuhrmann E, Coelho CC, Lauk LJ, Moll I, Jung EG. Expression of heat shock protein 27 in chromomycosis. Mycoses 1998;41:447-52  Back to cited text no. 1
2.Vollum DI. Chromomycosis: A review. Br J Dermatol 1977;96:454-8.  Back to cited text no. 2
3.Richardson MD, Warnock DW. Chromoblastomycosis. In: Fungal Infections: Diagnosis and Management. 3 rd ed. UK: Blackwell Publishing Ltd.; 2003.p. 288-92.  Back to cited text no. 3
4.Minotto R, Bernardi CD, Mallmann LF, Edelweiss MI, Scroferneker ML.Chromoblastomycosis: A review of 100 cases in the state of Rio Grande do Sul, Brazil. J Am Acad Dermatol 2001;44:585-92.  Back to cited text no. 4
5.Milan CP, Fenske NA. Chromoblastomycosis. Dermatol Clin 1989;7:219-25.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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