[rasheed]

A 45 year old women from California presented with fever, arthritis, pneumonia, and skin lesion over the anterior legs.
Skin scrapings treated with PAS stain revealed this

Image from CDC public domain - Dr. Gary Caroll

What is the treatment of choice
a- ampicillin
b- flucanazole
c- tetracycline
e- TMP-SMX
f- cephalosporin

 

[shahid]

 

[HouseWannabe]

e?? This question drove me up the wall, lol. There are only a few organisms that are Acid fast and can stain with PAS. I was thinking Nocardia psuedoTB but I have no idea...

 

[rasheed]

Answer

Diagnosis: Coccidiodis immitis
Treatment: Flucanazole
Clues: California, Pneumonia, Erythema nodosum
Micrograph: Tissue form, spherules

 

[HouseWannabe]

Can you please just explain why it would stain with PAS?

 

[rasheed]

Can you please just explain why it would stain with PAS?

Coccidiodes can be stained by regular H&E stain or PAS stain
See this emedicine article
http://emedicine.medscape.com/article/297976-diagnosis