Case Number : Case 2335 - 29 May 2019 Posted By: Dr. Hafeez Diwan

I see an ulcerated skin lesion and in the last 2 pictures there are some large oportunistic organisms that looks like acanthamoeba. So this should be a case of acanthamoebia cutis.

parakeratosis with hypogranulosis. some inflammatory cells in parakeratosis. there is vacuolar changes in basal cell layer

? drug rash

any PAS stain available

I also think the last 2 pictures show some kind of microorganisms. There is a hair follicle below so I would do deeper level sections to see whether the hair follicle is involved. Maybe just molluscum contagiosum.

Mound of parakeratosis about the follicular opening suggests seborrhoeic dermatitis in the setting of HIV infection. Clinical correlation needed. 

I thought about the possibility of nutritional deficiency dermatoses group (Zinc/acrodermatitis/NME and others) but obviously clinical correlation is essential.

The patient had extremely low protein/albumin levels.  Clinically this was felt to be kwashiorkor and histologically it fits with that.

amazing case

Great case, I was thinking nutritional deficiency too