A head-scratcher - bacterial or fungal?

Doctors in Nepal have reported the case of a 13-year-old patient with a burgeoning scalp abscess, the cause of which is commonly confused.

The severe swelling had a three-week history prior to presention, slowly growing in size despite treatment with oral antibiotics for suspected bacterial folliculitis and cellulitis.

On examination, doctors noted an erythematous, ‘boggy’ lesion covering the teen's occipital scalp, resulting in alopecia and mild tenderness (see panel A).