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Intradermal Bullous Dermatitis due to Candidiasis in an Immunocompromised Patient

Saul Suster, MD; Les B. Rosen, MD
JAMA. 1987;258(15):2106-2107. doi:10.1001/jama.1987.03400150098037.
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DISSEMINATED candidiasis has become one of the most frequent complications in immunocompromised patients.1 In some cases this may be difficult to establish, because Candida organisms are cultured from blood samples in only 25% of patients with systemic disease2 and serological tests may prove to be unreliable.3 Superficial cutaneous involvement by Candida organisms in immunocompromised patients is a wellrecognized complication; however, hematogenous spread to the skin is rare. A variety of skin lesions have been described in association with disseminated candidiasis, including subcutaneous nodules and pustules,4 verrucous plaques,5 macronodular hemorrhagic lesions,6 maculonodular rash,7 diffuse erythematous papular rash,8 necrotic pustules and ulcerative plaques mimicking ecthyma gangrenosum,9,10 and purpura fulminans.11 We report a previously undescribed complication of disseminated candidiasis, presenting as extensive hemorrhagic and bullous skin lesions. Histological examination of the lesions revealed intradermal bulla formation with massive involvement by Candida organisms. Early recognition


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