History and physical findings are the key to diagnosis. Histopathologic stains are of little help because the organisms are scarce in tissues. Fungal cultures are the best way to isolate the fungus, and tissue biopsy cultures often are diagnostic. Routine laboratory tests are nonspecific, but an increased white blood cell count, eosinophil count, and erythrocyte sedimentation rate may be noted. The differential diagnosis includes tuberculosis, tularemia, cat-scratch disease, leishmaniasis, staphylococcal lymphangitis, and nocardiosis.
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