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Case 3

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A 47 year-old female with a history of sarcoidosis and panhypopituitarism presented with a 2 week history of approximately six progressive, painful subcutaneous nodules on her extremities and trunk. Two of the nodules had recently ulcerated and were draining pus in small amounts. There was no history of local trauma. She was febrile on presentation, but was otherwise stable and comfortable. Blood cultures were also positive for the organism isolated from the skin biopsies. Lumbar puncture was negative.

Contributed by COL Robert Kazragis. Photomicrograph courtesy of Dr. Thomas Hirota, Dermatology Service, Moncrief Army Community Hospital, Fort Jackson, SC.

Special Staining of the biopsy was requested

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