Subject(s)
Corneal Diseases/diagnosis , Eye Infections, Fungal/diagnosis , Corneal Diseases/etiology , Corneal Diseases/microbiology , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/etiology , Dilatation, Pathologic/microbiology , Eye Infections, Fungal/complications , Eye Infections, Fungal/microbiology , Foreign-Body Reaction/complications , Foreign-Body Reaction/diagnosis , Foreign-Body Reaction/microbiology , Humans , Male , Saccharomyces cerevisiae/isolation & purification , Young AdultABSTRACT
BACKGROUND: Chromomycosis is a chronic fungal skin infection that generally presents in the form of verrucous or vegetative lesions on uncovered areas of skin. We report an unusual case of generalised chromomycosis due to Phialophora verrucosa. PATIENTS AND METHODS: A 42-year-old town-dwelling housewife was hospitalised for erythematous keratotic nodules on the arm showing sporotrichoid distribution, associated with a crusted ulcerative lesion on the homolateral index finger, as well as subcutaneous papulonodular lesions. In places, the lesions on the patient's back presented an umbilical and molluscoid appearance. The patient had suffered no previous injuries and had not visited any areas in which leishmaniasis is endemic. Her history included insulin-dependent diabetes. Screening for Leishman bodies was negative. Histopathological analysis of the skin biopsy revealed an epithelioid giant-cell granuloma with no caseous necrosis. The mycological study demonstrated the presence of fumagoid bodies and P. verrucosa was isolated. Treatment with terbinafine was initially given, followed by clarithromycin, but in the absence of any improvement, the patient was readmitted to hospital and is currently on itraconazole and amphotericin B. DISCUSSION: The novel features of our case comprise the clinical aspect of chromomycosis, the extent of the lesions, their unusual site on the back and upper limbs, and the isolation of a rare species, P. verrucosa (only the second observation in Morocco). It also highlights the therapeutic difficulties posed by this type of chromomycosis.
Subject(s)
Chromoblastomycosis/microbiology , Phialophora/isolation & purification , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Arm , Chromoblastomycosis/diagnosis , Chromoblastomycosis/drug therapy , Clarithromycin/therapeutic use , Diabetes Complications/diagnosis , Diabetes Complications/drug therapy , Diabetes Complications/microbiology , Diagnosis, Differential , Female , Hand Dermatoses/diagnosis , Hand Dermatoses/drug therapy , Hand Dermatoses/microbiology , Humans , Itraconazole/therapeutic use , Leishmaniasis, Cutaneous/diagnosis , Morocco , Naphthalenes/therapeutic use , Terbinafine , Tuberculosis, Cutaneous/diagnosisABSTRACT
Mycetoma is a rare disease in Morocco. The purpose of this work is to increase the awareness of this infection that is still not diagnosed in our context by Moroccan practitioners, as well as to show the medical treatment limits in Madura foot disease. This is a retrospective study of 15 patients with an average age of 34 years. All patients presented classic lesions: swelling fistulizing of slow evolution, with elective foot localization. In spite of the identification of pathogenic agents, the delay of diagnosis and the osseous infringement imposed amputations for 14 patients. After a 3-year follow-up, all patients with amputation had a good evolution with the help of adapted orthopedic equipment and psychological support. The delay of diagnosis and the advanced lesions of mycetoma in Morocco make the medical treatment ineffective. The recourse to leg amputation with suitable equipment is a simple alternative treatment that improves better social and professional reintegration. Mycetoma is characterized by an obvious delay of diagnosis. The forecast is worsened by the osseous infringement. Sometimes it can be dramatic and may lead to amputation.
