Nodules on the right ear.

A healthy 17-year-old boy with a one-year history of asymptomatic, slowly enlarging nodules affecting his right ear was seen. The patient’s past medical history was unremarkable, he was not immunosuppressed, he was not taking any drugs, and he was employed as a rubber worker in the Amazon region. Physical examination revealed ill-defined, smooth, shiny, hard nodules on his right ear (Figure 1). The consistency of the skin lesions was hard, and pain was absent. Regional lymph nodes were not enlarged. Laboratory examination showed unremarkable complete blood count, urinalysis, hepatic and renal function tests, serum glucose, ElisaHIV and erythrocyte sedimentation rate. Chest X-rays were normal. Histopathologic examination showed a diffuse granulomatous infiltrate involving the entire dermis, constituted by histiocytes and multinucleated giant cells (Figures 2, 3). The histiocyte’s cytoplasm contained rounded yeast-like hyaline cells with a thick double birefringent membrane. These cells were forming chains of multiple organisms. The GrocottDERmatology PRACTICAL & CoNCEPTUAL www.derm101.com