A 40-year-old agricultural worker from rural Brazil presents with chronic cough and mucosal ulcers of the mouth. Biopsy of the ulcer shows large yeast cells, up to 30 micrometres, with numerous smaller daughter cells budding simultaneously around the entire periphery of the mother cell. This appearance is described as:

• A Mariner's wheel or pilot wheel budding ✓
• B Broad-based budding
• C Spaghetti and meatballs pattern
• D Fission with a transverse septum

Explanation

Multiple peripheral simultaneous buds around a single mother yeast cell give the classic pilot wheel or Mickey Mouse cap appearance of Paracoccidioides brasiliensis, the agent of South American blastomycosis. Broad-based single buds characterise Blastomyces dermatitidis instead, which makes B the strongest distractor here. Fission with a transverse septum identifies Talaromyces marneffei, and the spaghetti and meatballs pattern describes Malassezia on skin scrapings.

Reference: Medical Mycology by Jagdish Chander, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.