Case for diagnosis
A 55-year-old female, who had had a kidney transplant 3 years ago and from then on, had\nbeen taking prednisone, tacrolimus and azathioprine with initial doses of 60, 150, and 2\nmg/day, respectively. These doses had been reduced and she is currently taking 10 mg\nprednisone, 100 mg azathioprine, and 1 mg tacrolimus daily. Two months ago while using\nthe same drug doses she presented asymptomatic lesions on the dorsum of her left hand\nwithout a history of local trauma.\nDermatological examination revealed a violet erythematous nodule and 2 other\nerythematous exulcerated papules on the dorsum of the left hand ().\nAn excisional biopsy of the nodule was performed for diagnosis. Histopathology showed\nchronic granulomatous inflammation and the presence of dark wall yeast structures\ncompatible with dematiaceous fungus ().\nThe other two lesions were also removed and the wound was closed with a double\nadvancement flap ().