20-Year History Of Slowly Growing Lesions

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A 41-year old farmer presented to the outpatient clinic of infectious disease with a complaint of numerous slowly growing lesions on his right leg. According to the patient’s history, the lesions on his leg had progressed over a time span of 20 years, causing gait abnormality. Initially, the lesions were painless pruritic papules on the knee that gradually spread to the dorsum of the foot.

Physical examination

Physical examination of the patient revealed associated skin changes with coalescent, subcutaneous nodules with verrucous lesions. Examination of the scraped lesions with 10% potassium hydroxide showed pigmented, thick-walled, multicellular structures, called sclerotic cells or Medlar bodies. The findings were consistent with chromoblastomycosis.

Chromoblastomycosis

Chromoblastomycosis is a chronic, subcutaneous mycosis (fungal infection) that develops on the skin at the site of trauma. The causative agent of chromoblastomycosis is a saphrophyte, Fonsecaea pedrosoi found in soil. Chromoblastomycosis is ubiquitous and is classified among the subcutaneous mycosis. However, the fungal infection is more prevalent in rural populations and in countries with tropical or subtropical climate, such as, Brazil in South America and Madagascar in Africa.

Daily treatment with oral itraconazole, 400 mg was initiated and continued for a year. Slight improvement was seen in the lesions during this time and further treatment was planned with cryotherapy.

References

Schwalb, A., & Seas, C. (2020). Chromoblastomycosis. New England Journal of Medicine383(2), e7.

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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