A 55-year-old man presented to the physician with a chronic cheek ulcer. The lesion, a reddened nodule measuring 0.5 cm, had developed 2 months earlier. He was treated with cephalexin, followed by amoxicillin/clavulanate, and then with moxifloxacin, but the lesion has not resolved.
It ulcerated slowly, without pain, and the patient was eventually referred to the infectious diseases service. Physical examination : Vital signs: Temperature, 99.4° F; pulse, 80 beats/min; respiratory rate, 16 breaths/min; blood pressure, 130/80 mm Hg Nickel-sized ulcer on the cheek, slightly raised edges, and nonpainful Laboratory results: WBC count: 9200 cells/µL Hemoglobin level: 11.2 g/dL Differential: 8% lymphocytes; 2% monocytes; 90% polymorphonucleocytes Culture: Cryptococcus gattii Biopsy: Yeast forms and granuloma Serum cryptococcal antigen: Negative HIV: Negative CD4 count: 186 cells/µL Source:…
