A 55-year-old man presents 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. PMH: Hypertension, no allergy, no drugs and no history of unprotected sex with multiple partners Physical Examination: Vital signs: temperature, 99.4° F; pulse, 80 beats/min; respiratory rate, 16 breaths/min; blood pressure, 130/80 mm Hg HEENT: nickel-sized ulcer on cheek, slightly raised edges, nonpainful Heart, lung, abdomen and extremities normal. Laboratory results: WBC count: 9200 cells/µL Hemoglobin level: 11.2 g/dL Differential: 8% lymphocytes; 2% monocytes; 90% polymorphonucleocytes Culture: Cryptococcus gattii…
