A 14-year-old girl developed 2 firm nodules at the site of a previous BCG vaccination. A skin biopsy revealed fungal structures typical of Loboa loboi, the agent responsible for Lobomycosis also known as keloidal blastomycosis. This deep fungal infection is characterized by slow growing keloid-like nodules or ulcerated verrucous plaques on exposed body sites. This infection is found almost exclusively in Central and South America. It affects humans and dolphins, and squamous cell carcinoma has been described as a rare complication in chronic lesions. Histopathology demonstrates extensive granulomatous inflammation, and fungal cells are readily identified both inside and outside of macrophages.
1 cm and 2 cm dome shaped firm smooth topped nodules