Diagnosis and therapy of chromoblastomycosis

Abstract

Chromoblastomycosis is a chronic deep mycosis of the skin and subcutaneous tissue. Clinical features are characterized by verrucous plaque lesions, especially in the lower extremities. The disease is difficult to cure and there is no gold standard therapy. A 72-year-old male farmer comes with thickened and bleeding skin on the left leg. For 10 years the thickened skin extends slowly from the back of the foot to the length of the left leg down to the bottom of the knee. A month earlier, the thickened skin becomes brittle and bleeding with hyperkeratotic plaques, verrucosa, multiple partial exudative, and hemorrhagic fissures. Scrapping skin lesions with 10% potassium hydroxide showing muriform cell (sclerotic bodies). Histopathological examination of granuloma inflammation composed of foamy macrophages, lymphocytes, histiocytes, multinucleated giant cells and many neutrophils, erythrocyte extravasation, and sclerotic bodies obtained in the brown dermis. Culture on Sabouraud dextrose agar media with chloramphenicol did not fungal colony growth. Patients have been treated with itraconazole 200 mg twice daily and showed clinical improvement after 3 weeks.  Diagnosis of chromoblastomycosis is based on history, physical examination, histopathology, and culture. The risk factors for the disease include farmers who work barefoot. Further evaluation is still needed regarding the therapy and complications in this case.