NODULAR SUBCUTANEOUS HISTOPLASMOSIS - A CASE-REPORT WITH DIAGNOSIS BYFINE-NEEDLE ASPIRATION BIOPSY

Fine needle aspiration biopsy (FNAB) of a solitary subcutaneous Module in the upper arm of a patient being treated with corticosteroids for chronic obstructive pulmonary disease contained numerous spherical, un stained, refractile particles mixed with necrotic cellular material an d rare intact histiocytes with yeastlike inclusions. The morphology of the extracytoplasmic spheroids and cytoplasmic inclusions, as demonst rated with Gomori methenamine silver stain, was characteristic of Hist oplasma capsulatum var capsulatum. This organism's identification was confirmed by excisional biopsy and microbiologic testing. If the chara cteristic intrahistiocytic, yeastlike forms are rare or absent, recogn ition of this peculiar, uncommonly encountered extracellular pattern i s crucial to the diagnosis of infection with H capsulatum. This patter n may become more common with increased numbers of immunosuppressed pa tients and increased use of FNAB.