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 Medicine, 383(2), e7.