Abstract
Chromoblastomycosis is a chronic subcutaneous mycotic infection caused by dematiaceous saprophytic moulds. The most frequently isolated agent is Fonsecae pedrosoi. This article reports a case of a man from the Amazon region in Northern Brazil who presented with a lesion of 12 months' duration, which gradually increased in size until covering the majority of his right leg. A successful treatment with itraconazole was performed.
Chromoblastomycosis; Dermatomycoses; Fibrosis; Fungal structures
A 45-year-old male farmer from the state of Amazonas, Northern Brazil, reported the onset
of a lesion on his left leg one year ago, which had an indolent growth until affecting his
entire left leg (Figure 1). The diagnosis of
chromoblastomycosis was confirmed by mycological and histopathological studies (Figures 2 and 3).
Clinical and laboratory tests (complete blood count, glycemia, anti-HIV, and urine) were
normal or negative. The patient has been using itraconazole 400mg/day and improved greatly
after 15 days (Figure 4) Chromoblastomycosis is a
chronic subcutaneous infection caused by dematiaceous saprophytic moulds. Clinical
manifestations are polymorphic and, in severe and long-lasting cases, different lesions may
be identified in the same patient: nodules, tumors, plaques, warts, and scars.11. Lupi O, Tyring SK, McGinnis MR. Tropical dermatology: Fungal tropical
diseases. J Am Acad Dermatol. 2005;53:931-51. In the case presented herein, verrucous plaques
accompanied by ulcers with angulated borders and geometric shape suggest
that the patient had a major role in the extensive disease involvement by scratching the
lesion, along with lymphatic dissemination. The remarkable fibrotic process, which was
previously considered a defense mechanism against chromoblastomycosis agents, may result
from the production of high levels of pyridinoline by the mould, which induces
cross-linking in tissue collagen fibrils.22. Sotto MN, De Brito T, Silva AM, Vidal M, Castro LG. Antigen
distribution and antigen- presenting cells in skin biopsies of human
chromoblastomycosis. J Cutan Pathol.;3:14-8.,33. Queiroz-Telles F, Santos DWCL. Chromoblastomycosis in the Clinical
Practice. Curr Fungal Infect Rep. 2012;6:312-9.,44. López Martínez R, Méndez Tovar LJ. Chromoblastomycosis. Clin
Dermatol. 2007;25:188-94. Therefore, these fibrils are resistant to
interstitial collagenase, due to their restricted access to catalytic sites.55. Ricard-Blum S, Hartmann DJ, Esterre P. Monitoring of extracellular
rmatrix metabolism and cross-linking in tissue, serum and urine of patients with
chromoblastomycosis, a chronic skin fibrosis. Eur J Clin Invest.
1998;28:748-54. Fibrosis, when occurring concomitantly to a chronic
inflammatory infiltrate and to a common secondary infection, impairs lymphatic flow.
Finally, anarchical tissue circulation leads to atrophy of skin and soft tissues, causing
deformities and disabilities, such as in the case reported herein.44. López Martínez R, Méndez Tovar LJ. Chromoblastomycosis. Clin
Dermatol. 2007;25:188-94. This condition is characterized by a higher growth in extension than
in depth. However, such extensive lesions such as those observed in the present case are
uncommon.66. Solórzano S, García R, Hernández-Córdova G. Cromomicosis: reporte de
um caso incapacitante. Rev Peru Med Exp Salud Publica 2011;28:552-5.
7. Correia RT, Valente NY, Criado PR, Martins JE. Chromoblastomycosis:
study of 27 cases and review of medical literature. An Bras Dermatol.
2010;85:448-54.
8. Criado PR, Valente NY, Brandt HR, Belda Junior W, Halpern I. Pedroso
and Gomes' verrucous dermatitis (Chromoblastomycosis): 90 years on and still among
us. An Bras Dermatol. 2010;85:104-5.-99. Mattêde MGS, Júnior LP, Coelho CC, Mattêde AF. Dermatite verrucosa
cromoparasitária (cromomicose). An Bras Dermatol. 1990;65:70-74.
Extensive and polymorphic lesion: ulcers, verrucous plaques with dark stippled lines and fibrotic areas that caused even severe penile lymphedema.
(A) Dramatic response after using itraconazole 400mg/day for 15 days; (B) Response maintained after 5 months of continuous use of the drug. Focuses of active areas were detected, interspersed with extensive cicatricial fibrous tissue
REFERENCES
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1Lupi O, Tyring SK, McGinnis MR. Tropical dermatology: Fungal tropical diseases. J Am Acad Dermatol. 2005;53:931-51.
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2Sotto MN, De Brito T, Silva AM, Vidal M, Castro LG. Antigen distribution and antigen- presenting cells in skin biopsies of human chromoblastomycosis. J Cutan Pathol.;3:14-8.
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3Queiroz-Telles F, Santos DWCL. Chromoblastomycosis in the Clinical Practice. Curr Fungal Infect Rep. 2012;6:312-9.
-
4López Martínez R, Méndez Tovar LJ. Chromoblastomycosis. Clin Dermatol. 2007;25:188-94.
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5Ricard-Blum S, Hartmann DJ, Esterre P. Monitoring of extracellular rmatrix metabolism and cross-linking in tissue, serum and urine of patients with chromoblastomycosis, a chronic skin fibrosis. Eur J Clin Invest. 1998;28:748-54.
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6Solórzano S, García R, Hernández-Córdova G. Cromomicosis: reporte de um caso incapacitante. Rev Peru Med Exp Salud Publica 2011;28:552-5.
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7Correia RT, Valente NY, Criado PR, Martins JE. Chromoblastomycosis: study of 27 cases and review of medical literature. An Bras Dermatol. 2010;85:448-54.
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8Criado PR, Valente NY, Brandt HR, Belda Junior W, Halpern I. Pedroso and Gomes' verrucous dermatitis (Chromoblastomycosis): 90 years on and still among us. An Bras Dermatol. 2010;85:104-5.
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9Mattêde MGS, Júnior LP, Coelho CC, Mattêde AF. Dermatite verrucosa cromoparasitária (cromomicose). An Bras Dermatol. 1990;65:70-74.
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Financial funding: None
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How to cite this article: Matos-Gomes N, Bastos TC, Cruz KS, Francesconi F. Chromoblastomycosis: an exuberant case. An Bras Dermatol. 2014;89(2):351-2.
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*
This study was conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMTAM)- Manaus (AM), Brazil.
Publication Dates
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Publication in this collection
Mar-Apr 2014
History
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Received
16 Mar 2013 -
Accepted
02 Apr 2013