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Case 1

1. Presented by Karen Carroll, MD and prepared by Robert Kruse, MD, PhD

Clinical vignette
An older patient with outdoor hobbies presents with an enlarging cutaneous ulcer. A wound culture grows Group B Streptococcus and a biopsy shows acute and chronic inflammation, prompting the clinician to treat the patient with antibiotics for presumed cellulitis. However, the ulcer continues to grow, raising concern for pyoderma gangrenosum. The lesion was biopsied again with corresponding images of H&E and special stains below.

Question: The morphology of the fungal elements highlighted on the GMS stain is consistent with: