Toxoplasmosis Presenting as Nonhealing Cutaneous Ulcer

Area of Science:

• Medical Mycology
• Dermatology
• Infectious Diseases

Background:

• Systemic toxoplasmosis typically affects immunocompromised individuals.
• Cutaneous manifestations often accompany systemic disease.
• Isolated cutaneous toxoplasmosis in immunocompetent hosts is exceptionally rare.

Observation:

• A 64-year-old immunocompetent female presented with a year-long nonhealing ulcer on her left hand.
• Dermatological examination revealed a chronic ulcer.
• Initial serological tests for toxoplasmosis were negative.

Findings:

• Biopsy of the ulcer showed dense dermal inflammatory infiltrates with plasma cells, lymphocytes, and multinucleated giant cells.
• Focal abscess formation was noted in the dermis.
• Periodic Acid Schiff staining identified organisms resembling *Toxoplasma gondii* tachyzoites.

Implications:

• This case underscores the potential for primary cutaneous toxoplasmosis in immunocompetent patients.
• Clinicians should consider toxoplasmosis in the differential diagnosis of chronic, nonhealing skin ulcers.
• Further investigation may be warranted even with negative serology in specific clinical scenarios.