Case Number : Case 1469 -10 February Posted By: Guest

Beautiful hyphae!

Seem like acute superficial folliculitis and perifolliculitis probably of fungal ethiology. I would perform special stains, it looks like septated but to be honest I am not 100% sure with the pictures, they also look like elastic fibers... 

Fungal suppurative granulomatous folliculitis ( Trichophyton rubrum? )

Agree, fungal folliculitis.

Have another go surely!

My other differential was elastosis perforans serpiginosa that usually affects the face but there is too much inflammation on the dermis. Special techniques are important would perform PAS, Grocott, orcein,

Herpes.

Herpes. Multinucleate cells in wall of the follicle, with margination of chromatin. Look like septate hyphae, when looked at fleetingly!  Some elastin fibres are also noted.

Herpes simplex folliculitis.  Immunohistochemistry (HSV) nicely highlighted these multinucleated cells in the wall of the follicle.  

Never thought herpes inclusions and fungal hyphae could be confused with each other! Have to admit I thought fungal too, so  we all fell into the trap (except ofcourse the great Dr Carr, who obviously did not have any doubts!)

Great case!