In mid- December, a woman with insulin- dependent diabetes who had been on prednisone fell and received an abrasion on the dorsal side of her right hand. She was placed on penicillin. By the end of January, the ulcer had not healed, and she was referred to a plastic surgeon. On January 30, a swab of the wound was cultured at 35°C on blood agar. On the same day, a smear was made for Gram staining. The Gram stain showed large (10 µm) cells. Brownish, waxy colonies grew on the blood agar. Slide cultures set up on February 1 and incubated at 25°C showed septate hyphae and single conidia. The most likely cause of the infection is a

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The large (10 µm) cells seen on the Gram stain suggest a fungal infection. The brownish, waxy colonies and the presence of septate hyphae and single conidia on slide cultures indicate a fungal infection caused by a dimorphic fungus. The fact that the cultures were incubated at both 35°C and 25°C is also indicative of a dimorphic fungus.

In Mid- December, a Woman with Insulin- Dependent Diabetes Who