268 The Philippine Journal of Science is^e 



The case from which this fungus was isolated was encountered 

 among a number of leper suspects, among whom unfamiliar types 

 of skin infections are occasionally to be seen. This individual, 

 who presented multiform lesions of several types, proved to be 

 nonleprous; he was, however, kept under observation for some 

 time. The principal features of the case, so far as they can be 

 determined, are as follows : 



CASE HISTORY 



The patient is a male Filipino (Tagalog), laborer, aged about '60 yeiirs, 

 resident in Manila for some years. He says that in July or August, 1915, 

 an ulcerative lesion appeared below the left elbow. This healed, but soon 

 reappeared, involving a wider area, beyond v/hich it spread slowly. At 

 about the same time a number of similar spreading lesions appeared 

 simultaneously on other parts. The patient experienced a chill at the time 

 of onset, but thinks that he had no fever. These lesions spread over con- 

 siderable areas as evidenced by the cicatrices, some of which are of consider- 

 able thickness and resemble keloids (fig. 5). About four months later 

 numerous small, scattered lesions began to appear, said to have directly 

 followed a three-day course of some medication. 



Upon examination (June 6, 1916) the lesions are seen to be very nu- 

 merous and varied. On the legs and feet there seems to be little normal 

 skin left. The hands and forearms are also very much involved. 



Small, early lesions are present in great numbers over the back (fig. 1), 

 forearms (fig. 4), and legs and to a less extent on the arms, thighs, and 

 shoulders. These are very superficial, erythematous, slightly laised, and 

 somewhat indurated areas, irregular in size and outline, in which are 

 numerous fine papules usually pinhead-sized or smaller. These are not 

 tender on pressure. In and immediately about the areas, except over the 

 papules, the epidermis is pigmented, sometimes to a deep brown. It was 

 probably the peculiar appearance of these small lesions, together with 

 a nodular induration of the lobes of the ears (fig. 2), that had caused the 

 patient to be submitted for examination as a suspected leper. 



The small lesions seem more commonly to subside, leaving slight scars 

 or disappearing completely. Over the wrists and hands, feet and ankles, 

 the elbows and the knees, and even on the upper margins of the ears (fig. 2), 

 numbers of them have progressed to form rather prominent verrucss, which 

 vary in color from white to a dark gray. These apparently develop by a 

 low-grade inflammatory hyperplasia. 



A more striking type of lesion, comparatively acute, which apparently 

 originates with the common small lesion, is a relatively large framboesial 

 nodule (fig. 3), which extends over a part or the whole of a papular area, 

 often encroaching on the adjacent skin. These lesions are abruptly raised 

 and usually oval, measuring from 1 to 2 centimeters in width and from 

 1.5 to 2.5 or 3 centimeters in length. The covering epidermis is thin, 

 shiny, and transparent, and thin scales usually form upon it. It is ap- 

 parently easily injured. Beneath it, in the more or less dark gray to 

 purplish gray newly formed tissue, are seen red pinhead-sized points sug- 

 gesting vascular spaces and others which are pale gray to yellowish, 

 apparently due to necrosis or suppuration. A somewhat .similar acute 

 lesion sometimes develops by recurrence in scar tissue (fig. 5, indicated). 



