A 64-year-old female presented to the Dermatology Outpatient Department, BPKIHS, with complaints of a nonhealing ulcer over dorsum of the left hand for one year. There was no any history of diabetes, hypertension, and tuberculosis and no any history of trauma over the site. The lesion started as a small papule which over time increased in size and got ulcerated. On examination, there is crusted plaque with oozing pus mixed with blood with granulation tissue at the base of size 3 x 3 cm (Figure 1).
An incisional biopsy of the lesion was sent for histological examination which showed epidermis lined by keratinized stratified squamous epithelium with parakeratosis, plasma crusting and focal neutrophilic infiltration, and pseudocarcinomatous hyperplasia. Dermis revealed suppurative to early plasma cell granulomas, along with eosinophils, macrophages, multinucleated giant cells, and focal abscess formation (Figure 2).
Crescent-shaped organisms with a pointed anterior end and rounded posterior end were seen in the dermis with morphological resemblance to tachyzoites of Toxoplasma gondii which were positive for Periodic Acid Schiff (PAS) but negative for Silver Methenamine (SM) (Figures 3(a) and 3(b)).