Case Study: April 2013


  • 10 year old female
  • Recent visit to South-East Asia
  • Gives a very clear history of being bitten on the eyebrow and earlobe by ‘black flies’
  • Develops ulcerated lesions at site of fly bites
  • Also has post-auricular lymphadenopathy on side of earlobe lesion
  • Biopsy of eyebrow lesion and lymph node
  • Fig 1 and 2 – skin lesion
  • Fig 3 is lymph node


  1. What is the histological reaction pattern seen in Fig 1 and 2?
  2. What is the differential diagnosis?
  3. What does Fig 3 of the lymph node show?
  4. What is the most plausible diasgnosis?
Click to show answers
  1. Necrotising granulomas / granulomatous inflammation
  2. Infection (myocbacteria, fungi, parasitic mainly)
  3. A granulomatous lymphadenitis.
  4. Leishmania given the clear history of fly bites. Despite the absence of organisms in the macrophages, the PCR performed on fresh tissue was positive.