Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

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Diagnose this case by Zeinah AlHalees, MD, and AlReem Al-Nabti, MD

An otherwise healthy 40-year-old male presented to the dermatology clinic with skin lesions on the right upper arm and right lateral lower leg. He reported the appearance of the lesions a few weeks after his return from a trip to Algeria. His review of systems was negative. On physical exam, two erythematous verrucous plaques were noted on the right upper arm and four ulcerated plaques in a sporotrichoid distribution were evident on the right lateral lower leg. There was no mucous membrane involvement, and no associated regional adenopathy. Parasitized macrophages in the dermis were identified on histopathology with the organisms highlighted by Giemsa stain and CD1a immunostaining. The specimen was also sent for PCR.

1. What is the diagnosis and causative agent?

2. What is the vector responsible for disease transmission?

3. This disease can be classified based on two different classification systems, mention each system with its components.

4. Mention two limitations in culturing the organism.

5. What test is considered to be the most specific and sensitive in diagnosing the disease?

6. What are the indications for systemic treatment of the disease?

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