Volume 4, Issue 10, Pages (November 2018)

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Volume 4, Issue 10, Pages 1007-1009 (November 2018) Fatal blastomycosis after exogenous immunosuppression in a healthy gardener Jessica Lu, Thusanth Thuraisingam, MD, PhD, May Chergui, MD, FRCPC, Beatrice Wang, MD, FRCPC, Cedric P. Yansouni, MD, FRCPC, DTM&H JAAD Case Reports Volume 4, Issue 10, Pages 1007-1009 (November 2018) DOI: 10.1016/j.jdcr.2018.08.019 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Large, broad-based budding yeast cells seen by direct calcofluor white staining of broncho-alveolar lavage fluid. Large yeast cells are approximately 16 μm in diameter. The large number of yeast seen, the very large size of cells, and broad-based budding distinguish Blastomyces sp from nearly all other dimorphic fungi. JAAD Case Reports 2018 4, 1007-1009DOI: (10.1016/j.jdcr.2018.08.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A 1- × 2.7-cm plaque with a hemorrhagic crust and an erythematous border was identified on the patient's left forehead on admission. JAAD Case Reports 2018 4, 1007-1009DOI: (10.1016/j.jdcr.2018.08.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Ulcer with underlying loose granulomatous inflammation and large round budding yeastlike organisms show broad-based budding, characteristic of blastomycosis. (A, Hematoxylin-eosin stain; original magnification: ×100; B, Grocott stain; original magnification: ×400.) JAAD Case Reports 2018 4, 1007-1009DOI: (10.1016/j.jdcr.2018.08.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions