Case 173. Paracoccidioidomycosis (32 y-o F)
Biopsy from an ulcerative facial skin of a Brasilian Nisei
Key words : Paracoccidioides brasiliensis, paracoccidioidomycosis
Large-sized, yeast-form fungi are phagocytized by multinucleated giant cells (HE, low power). Abscess is formed among the granulomatous reaction (suppurative granuloma).   Paracoccidioides brasiliensis showing a double-coutour appearance is morphologically resembles Blastomyces dermatitidis. Careful observation discloses a multiple budding form, characteristic of P. brasiliensis (HE, high power).
Grocott's silver clearly shows the multiple budding yeast, accompanying "ship's steering wheel appearance". Paracoccidioidomycosis is endemic in the south American continent.