The Deep Mycoses (Essentially or Potentially Systemic) 209 



iik-cratc. Healing ma) occur, or papillomatous fungating lesions may result. 

 The secondar) lesions ma) occur in the subcutaneous tissue, causing flaccid 

 abscesses, some oi which reach a large size. Lesions resembling gummas and 

 other granulomas, such as tuberculosis verrucosa cutis, are not unknown. 

 Scrofuloderma may be simulated in the rare eventuality that the disease 

 invades the superficial lymph nodes. The pus present in active lesions is 



67, ( loccidioidorrn cosis. 



thick, yellowish gray and ropy. Temporary healing results from formation of 

 sear tissue. Disfigurement and limitation of movement may be produced. 



When generalization occurs, almost any tissue or organ may become in- 

 volved. The symptoms may be mild at first, and the course nia\ be pro- 

 longed. However, if there is rapid and widespread dissemination, a spiking 

 fe\ <t. pain, loss of weight and general debility occurs, leading to death with- 

 in a few weeks. The bones and joints are rather vulnerable, the infection 

 reaching them through the blood stream. The ankle, the w i ist and the elbow 

 joints are involved in this order of frequency. An infected joint is swollen 

 and painful and is in effect the site ol acute arthritis. The bones of the 

 foot, the ankle joints, the- ribs and the vertebral column are those most 

 commonly affected. The lesions are usually of the type of destructive osteo- 

 myelitis and are accompanied by slight pain and tenderness. Pus may bur- 



