viernes, 11 de septiembre de 2015

An Exophytic Mass on the Mandible of an Immunocompromised Man - QUIZ

Figure 1. An exophytic mass of the mandible. A firm, 7-cm exophytic
and violaceous nodule surrounded by multiple agminated, violaceous
papules was present on the right mandible.

Figure 2. Punch biopsy of the mandible. A, Hematoxylin-eosin stain
(×100 magnification). B, Mucicarmine stain (×400 magnification).

A man in his thirties presented with a slowly growing, painful, swollen mass overlying his right mandible. He was diagnosed with human immunodeficiency virus 10 months prior and had not undergone treatment. The mass initially appeared as a “small bruise” that had enlarged over the preceding 6 months. 
The cutaneous lesion was accompanied by a nonproductive cough, dyspnea, weight loss, and progressive bilateral swelling of the patient’s lower extremities. Clinical examination revealed a firm, well-circumscribed, 7-cm exophytic and violaceous nodule on the right mandible. Superolateral to this lesion were multiple agminated, firm, and violaceous papules (Figure 1).
The skin underlying and between these lesions was thickened, hyperpigmented, and tender to palpation. The patient also had a thin purple-gray plaque on his right inner buccal mucosa extending to the margin of the lower lip. Breath sounds were absent with dullness to percussion on the left side of his lungs. His lower extremities were notable for pitting edema to the knees, most prominent over the dorsa of his feet. A punch biopsy of a mandibular papule was performed and sent for histologic evaluation (Figure 2A and 2B).

What is your diagnosis?

Clinical Infectious Diseases 2014;58(4):540
DOI: 10.1093/cid/cit711

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