Multiple asymptomatic verrucous plaques over the legs
Pradeep Vittal Bhagwat
Department of Skin and STD, Karnataka Institute of Medical Sciences, Hubli - 580 022, Karnataka
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Bhagwat PV, Tophakhane RS, Kudligi C, Noronha T. Multiple asymptomatic verrucous plaques over the legs. Indian J Dermatol Venereol Leprol 2010;76:86
A 60-year-old male farmer presented to us with verrucous lesions over the right leg of five-year duration. Patient does not remember any trauma to this site prior to the onset of the lesion. On clinical examination, he had mild pallor. Cutaneous examination revealed a well demarcated, indurated, non-tender, verrucous plaque measuring 10 cm Χ 12 cm, situated over the lateral aspect of the lower half of the right leg, extending on to the pre-tibial area [Figure - 1]. Surface was covered with blackish crusts at some places. A few lesions of similar morphology but of smaller sizes were distributed around the bigger lesion. There was a similar plaque measuring 3 cm in diameter situated over the medial aspect of the middle one-third of the left leg. There was no significant, regional lymphadenopathy. Systemic examination was unremarkable.
On investigation, the patient had hemoglobin of 10 gm/ dl. Other routine investigations and radiological examinations were normal. KOH mount of the crust revealed brownish muriform bodies [Figure - 2]. The lesion over the right leg was biopsied and subjected to the histopathological examination which revealed sub-epithelial dense aggregates of lymphocytes, neutrophils and epithelioid cells forming granulomas and brownish sclerotic bodies. The crusts present over the lesion were collected in a sterile bottle and sent for culture. After two weeks of incubation in Sabouraud′s 2% glucose agar, velvety olive-black colonies were grown [Figure - 3]. Lactophenol cotton blue mount of the smear prepared from the culture revealed long chains of elliptical conidia borne from erect, tall, branching conidiophores. Hyphae were septate and brown in color. Conidiophores were long and branched, and gave rise to chains of darkly pigmented budding conidia.
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