ABSTRACT
Microscopic examination of the lesions revealed spherical organisms, of variable size, with a doubly refractile outer membrane, morphologically resembling “psorospermiae”. The patient, a middle-aged soldier, presented with verrucous patches on his nose and cheek. Alejandro Posadas, a medical student who was working in the pathology laboratory of Robert Wernicke, considered the disease to be neoplastic, similar to mycosis fungoides. Erythema nodosum develops in approximately 15% of persons with primary coccidioidal infection, with a higher incidence in females than in males.19–24 This clinical syndrome is usually coincident with the acquisition of delayed hypersensitivity to the fungus and thus is considered to be an allergic phenomenon. This temporal relationship suggests that cell-mediated immunity contributes to host defense in coccidioidomycosis, whereas, antibody is either inconsequential or perhaps detrimental, a concept that has received considerable support from studies of humans and experimental animal models.
