Cromomicosis: presentación de un caso / Chromomycosis: a case report

Fundamento: la cromomicosis es una micosis subcutánea, crónica, ocasionada por hongos dematiáceos o feoides de los géneros Fonsecaea, Cladophialophora, Phialophora, Rhinocladiella y Exophiala, entre otros. Afecta piel y tejido celular subcutáneo en extremidades inferiores, sobre todo en pies, se caracteriza por lesiones verrugosas, nodulares o atróficas y es de difícil tratamiento. Los hongos que causan la cromomicosis pueden aislarse en el ambiente a partir de madera, los restos de plantas o el suelo.Objetivo: presentar el caso clínico de un paciente con el diagnóstico de cromomicosis.Caso clínico: paciente masculino de 56 años de edad, trabajador agrícola, que hace alrededor de 15 años presentó lesión de antebrazo izquierdo, que creció de forma lenta hasta alcanzar un gran tamaño, por lo que acudió a consulta médica en su municipio, fue remitido a la consulta de Dermatología. Al examen dermatológico se constata un cuadro cutáneo localizado constituido por una lesión en placa eritematoescamosa, con costras aisladas de bordes bien definidos, arciformes de veinte centímetros, imbricados con zonas hipocrómicas, que asienta en región medial posterior de brazo y antebrazo izquierdo. Resto del examen físico sin alteraciones.Conclusión: la cromomicosis es una enfermedad rara, que conlleva complicaciones, por lo que es importante tener en cuenta la enfermedad para su diagnóstico precoz(AU)

Background: chromomycosis is a chronic subcutaneous mycosis caused by dematiaceous or feoid fungi from the genera Fonsecaea, Cladophialophora, Phialophora, Rhinocladiella and Exophiala, among others. It affects skin and subcutaneous cellular tissue, preferably in the lower extremities, especially in feet, characterized by warty, nodular or atrophic lesions and it is difficult to treat. Fungi that cause Chromomycosis can be isolated in the environment from wood, plant remains or soil.Objective: to present the clinical case of a patient diagnosed with chromomycosis.Case report: a 56-year-old male, agricultural worker, who presented a left forearm lesion approximately 15 years ago, which grew slowly until reaching a large size, so he went to medical consultation in his municipality, being referred to the dermatology consultation. Dermatological examination showed a localized cutaneous lesion consisting of an erythematous-scaly lesion, with isolated scabs with well-defined edges, approximately 20 centimeters long, imbricated with hypochromic zones, which sit in the posterior medial region of the left arm and forearm. The rest of the physical examination did not present alterations.Conclusion: chromomycosis is a rare disease, leading to complications. Therefore it is important to consider the disease for its early diagnosis(AU)

First case of chromoblastomycosis due to Phoma insulana.

Chromoblastomycosis is a chronic infection, caused by pigmented fungi affecting skin and subcutaneous tissues characterized by verrucous nodules or plaques. Fonsecaea pedrosoi and Cladophialophora carrionii are the prevalent agents in the endemic areas. Phoma is an uncommon agent of human infection and involved mainly with phaeohyphomycosis cases. The case of a patient with a history of laceration in foot followed by verrucous aspect and scaly lesions, which had evolved for 27 years is presented. On physical examination disease was clinically compatible with chromoblastomycosis and the microscopic examination of scales showed fumagoid cells. On culture a dematiaceous fungus was grown. The agent was confirmed to be Phoma insulana based on its morphology and PCR-sequencing. This fungal agent has not been previously reported in association with this pathology.

Unique case report of a chromomycosis and Listeria in soft tissue and cerebellar abscesses after kidney transplantation.

BACKGROUND: Chromomycosis is a rare mycotic infection encountered in tropical and subtropical regions. The disease presents as a slowly-evolving nodule that can become infected with bacteria. Here, we describe a unique association of abscesses caused by a chromomycosis and Listeria monocytogenes in a kidney transplant recipient, and didactically expose how the appropriate diagnosis was reached. CASE PRESENTATION: A 49-year old male originating from the Caribbean presented a scalp lesion which was surgically removed in his hometown where it was misdiagnosed as a sporotrichosis on histology, 3 years after he received a kidney transplant. He received no additional treatment and the scalp lesion healed. One year later, an abscess of each thigh due to both F. pedrosoi and L. monocytogenes was diagnosed in our institution. A contemporary asymptomatic cerebellar abscess was also found by systematic MRI. An association of amoxicillin and posaconazole allowed a complete cure of the patient without recurring to surgery. Histological slides from the scalp lesion were re-examined in our institution and we retrospectively concluded to a first localisation of the chromomycosis. We discuss the possible pathophysiology of this very unusual association. CONCLUSION: In this case of disseminated listeriosis and chromomycosis, complete cure of the patients could be reached with oral anti-infectious treatment only.

Plaques on dorsal hands & arms.

This patient's slow-growing lesions hadn't responded to topical steroids or antifungals. Careful consideration of her work environment led us to a curious diagnosis.

Clinical and demographic profile of chromoblastomycosis in a referral service in the midwest of São Paulo state (Brazil).

Chromoblastomycosis is one of the most frequent deep mycoses found in rural populations. This cross-sectional, retrospective and descriptive study was conducted with cases of chromoblastomycosis diagnosed throughout 20 years. A higher prevalence was observed among White male rural workers, with an average age of 59.69 years. Median time between onset of symptoms and diagnosis was 156 months. Lesions were predominantly located on the lower limbs; 34% of cases reported previous trauma. The most common associated symptoms were itching, pain and burning sensation. Mycological examination was positive in 91% of cases and Fonsecaea pedrosoi was the most prevalent etiologic agent.

Non-healing verrucous plaque over upper limb for 1 year in a tea garden worker.

A 55-year-old tea garden worker presented with a slowly growing verrucous plaque on the right arm. The diagnosis of chromomycosis was confirmed by the identification of brown sclerotic bodies in a skin biopsy.

Host defenses in subcutaneous mycoses.

Subcutaneous mycoses include diverse clinical syndromes, characterized by invasion of the skin and subcutaneous tissue by saprobic fungi. Individuals living in rural areas constantly suffer lesions or trauma; however, only a few of them develop disease. In this contribution, we describe recent advances in the understanding of the virulence of these organisms, focusing on the most prevalent infections, sporotrichosis, chromoblastomycosis, and mycetoma. Although these infectious diseases are considered neglected tropical diseases, modern molecular techniques have been able to identify the etiologic agents and observe variations in the former monolithic concept of the species, which was based mostly on morphologic characteristics. The complete genetic characterization of the causative agents, along with that of their host, will help in the understanding of the factors on which the development of these infections depends.

Chromoblastomycosis after a leech bite complicated by myiasis: a case report.

BACKGROUND: Chromoblastomycosis is a chronic mycotic infection, most common in the tropics and subtropics, following traumatic fungal implantation. CASE PRESENTATION: A 72 year-old farmer was admitted to Luang Namtha Provincial Hospital, northern Laos, with a growth on the left lower leg which began 1 week after a forefoot leech bite 10 years previously. He presented with a cauliflower-like mass and plaque-like lesions on his lower leg/foot and cellulitis with a purulent tender swelling of his left heel. Twenty-two Chrysomya bezziana larvae were extracted from his heel. PCR of a biopsy of a left lower leg nodule demonstrated Fonsecaea pedrosoi, monophora, or F. nubica. He was successfully treated with long term terbinafin plus itraconazole pulse-therapy and local debridement. CONCLUSIONS: Chromoblastomycosis is reported for the first time from Laos. It carries the danger of bacterial and myiasis superinfection. Leech bites may facilitate infection.

Unusual presentation of chromoblastomycosis due to Cladophialophora carrionii in a renal and pancreas transplant recipient patient successfully treated with posaconazole and surgical excision.

Chromoblastomycosis is a chronic, tropical and subtropical, subcutaneous mycosis caused by inoculation of dematiaceous molds. This disease is uncommonly reported in patients who have undergone solid organ transplantation. We describe a case of chromoblastomycosis caused by Cladophialophora carrionii that occurred 7 years after transplantation in a 58-year-old male renal and pancreatic transplant recipient. Diagnosis was based on histopathology and isolation of multiple colonies of the dematiaceous mold in pure culture. Identification was achieved by sequencing of the internal transcribed spacer regions of the rRNA. The patient was successfully treated with posaconazole and surgical excision of a residual lesion.

Pápulas verrugosas perianales en paciente con síndrome de Bannayan-Riley-Ruvalcaba / Perianal Verrucous Papules in a Patient with Bannayan-Riley-Ruvalcaba Syndrome

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Difficult mycoses of the skin: advances in the epidemiology and management of eumycetoma, phaeohyphomycosis and chromoblastomycosis.

PURPOSE OF REVIEW: Eumycetoma, phaeohyphomycosis and chromoblastomycosis are subcutaneous mycoses having in common the fact that they are acquired as a result of penetrating trauma to the skin and may be caused by a large variety of fungi. This article will review recent data regarding the epidemiology and treatment of these infections. RECENT FINDINGS: Recent epidemiologic observations in these mycoses include an increased incidence of phaeohyphomycosis in immunosuppressed patients, the association of polymorphisms in genes involved in innate immunity, the occurrence of eumycetoma caused by Madurella mycetomatis and the nosocomial acquisition of phaeohyphomycosis. The management of these infections continues to be challenging. An approach that involves early diagnosis, the use of systemic antifungal agents and local therapies, including surgical removal of lesions, is the basis of the treatment of these diseases. SUMMARY: It is crucial that the epidemiology and clinical presentation of these infections are understood if we are to improve their outcomes.

Chromoblastomycosis associated with Fonsecaea pedrosoi in a carpenter handling exotic woods.

Chromoblastomycosis is a rare, hard to diagnose disease that arises mostly in the tropics, especially in humid areas, affecting mainly males and rural workers. It is characterized by verrucous plaques or nodules that are slow growing and attributed to infection by different pigmented (dematiaceous) fungi. Usually the infection develops after injury, being primarily located on the lower extremities. The authors present the case of a healthy, 60-year-old man observed with a one year history of an erythematous violaceous 5cm tumor located on the right thigh. A biopsy specimen for histopathology revealed single or clustered brown pigmented cells, with a single or double septum and thick cell walls. Cultural smears showed growth of Fonsecaea Pedrosoi. The patient was treated with oral itraconazole (200mg per day), with a good response and clinical cure in 6 months that left only an atrophic scar.

A rare case of chromoblastomycosis in a renal transplant recipient caused by a non-sporulating species of Rhytidhysteron.

We report a rare case of chromoblastomycosis caused by a non-sporulating species of Rhytidhysteron (Order Patellariales, Ascomycota) which was identified by molecular methods. The patient was a post-renal transplant recipient male aged 50 years and a resident of Delhi. The diagnosis was made by direct microscopy, histopathology and isolation of multiple colonies of the dematiaceous mould in pure culture. The samples used to recover the organism were obtained from a biopsy of one of the lesions occurring on his left foot and extending to the shin and thigh. The lesions comprised necrotic granulation tissue with indurated and thickened margins. After 2 weeks of therapy with itraconazole, 100 mg twice daily, the lesions partially retracted. However, the patient developed complications of acute abdominal pain with respiratory distress, necessitating admission to a tertiary-care hospital where he died due to multiple organ failure within 48 h. All attempts to induce sporulation of the fungal isolate on various mycological culture media were unsuccessful. Thereafter, sequencing of the 18S rRNA gene of the isolate and its comparison with GenBank database revealed that the fungus belonged to the genus Rhytidhysteron. As far as we are aware, this is the first case of human infection caused by a fungus of the Order Patellariales. The case underlines the relevance of molecular techniques as valuable tools for identification of non-sporulating opportunistic pathogenic fungi.

Extensive chromoblastomycosis caused by Fonsecaea pedrosoi successfully treated with a combination of amphotericin B and itraconazole.

Chromoblastomycosis is a chronic infection caused by dematiaceous (dark-colored) fungi which affect the skin and subcutaneous tissues, and is characterized by a wide variety of clinical and dermatological features including papillomatous, verrucous and vegetating lesions. Although it has been described world-wide, most cases originate in tropical and sub-tropical areas. In general, present treatments of the disease are unsatisfactory as one of the most common etiologic agents, Fonsecaea pedrosoi is difficult to manage from a therapeutic point of view. We report a case of extensive chromoblastomycosis of 22 years duration caused by F. pedrosoi and review the clinical course, diagnosis and management of this disease.

Cromomicosis: a propósito de dos casos / Chromomycosis: report of 2 cases

Se presentan dos casos de cromomicosis, de diferente sexo, ambos oriundos de Paraguay, con lesiones de distinta localización, cuyo agente etiológico fue Fonsecae Pedrosoi. Ambos respondieron al tratamiento con itraconazol 400 mg/día, sin que se presenten efectos indeseables. El tiempo de tratamiento promedio fue de 6 meses para ambos con muy buena evolución. La cromomicosis es una enfermedad producida por hongos dematiáceos de distribución universal, de climas tropicales y subtropicales. La lesión consiste en un nódulo rojo-violáceo que se ulcera volviéndose vegetante para luego formar placas infiltradas y costrosas, que muchas veces evolucionan a la fibrosis cicatrizal. Se han ensayado múltiples tratamientos todos con resultados variables, siendo el itraconazol con el que mejor respuesta se logró en la mayoría de las series publicadas (AU)

Treating chromoblastomycosis with systemic antifungals.

Chromoblastomycosis is a subcutaneous mycosis for which there is no treatment of choice but rather, several treatment options, with low cure rates and many relapses. The choice of treatment should consider several conditions, such as the causal agent (the most common one being Fonsecaea pedrosoi ), extension of the lesions, clinical topography and health status of the patient. Most oral and systemic antifungals have been used; the best results have been obtained with itraconazole and terbinafine at high doses, for a mean of 6 - 12 months. In extensive and refractory cases, chemotherapy with oral antifungals may be associated with thermotherapy (local heat and/or cryosurgery). Limited or early cases may be managed with surgical methods, always associated with oral antifungal agents. It is important to determine the in vitro sensitivity of the major causal agents to the various drugs, by estimating the minimum inhibitory concentration, as well as drug tolerability and drug interactions.