Blastomycosis

A 32-year-old man presents to his primary care provider for evaluation of fatigue and a nonproductive cough, which developed one month ago. Medical history is notable for hypertension and HIV infection. The patient is uninsured and has limited access to healthcare. He has not traveled overseas and has been living in Ohio for the past five years. Temperature is 38.2°C (100.8°F), blood pressure is 148/83 mmHg, and pulse is 98/min. On physical examination, the lung fields are clear to auscultation. Verrucous lesions are present over the trunk and upper extremities. Abdominal examination is unremarkable. No oral mucosal lesions are identified. Which of the following best describes the microscopic appearance of the organism responsible for this patient’s symptoms?