The Role of Excision for Treatment of Chromoblastomycosis: A Cutaneous Fungal Infection Frequently Mistaken for Squamous Cell Carcinoma.

BACKGROUND: Chromoblastomycosis is an uncommon fungal infection of the skin caused by a variety of dematiaceous fungal species that is typically contracted through direct inoculation into the skin. OBJECTIVE: To collect and examine data pertaining to the clinical presentation and management of patients with chromoblastomycosis. METHODS: Through a retrospective study, a pathology medical record search was performed from January 2004 to December 2020 at a single institution. RESULTS: A total of 9 patients were identified. Seven of 9 cases occurred in solid organ transplant recipients. All cases were located on the extremities. Six of 9 cases were clinically suspected to be squamous cell carcinoma. Seven of 9 cases were treated with surgical excision. Six of 9 patients were treated with oral antifungal medication. Four of 9 patients had received combination therapy. Eight of 9 patients had no recurrence of the disease after treatment. CONCLUSION: Chromoblastomycosis presents as verrucous papules or nodules and may clinically and histopathologically mimic squamous cell carcinoma. Immunosuppression is likely a risk factor for the development of chromoblastomycosis. This study highlights the importance of clinical awareness of this disease's clinical presentation and prevalence in immunosuppressed patient populations.

Chromoblastomycosis in Taiwan: A report of 30 cases and a review of the literature.

Chromoblastomycosis (CBM) is an implantation mycosis characterized by the presence of pigmented muriform cells in tissue. CBM is endemic in Taiwan, but only three formal cases have been reported to date because of underreporting. To describe and update its epidemiologic features, we report a series of 30 cases between 2003 and 2016 at a single medical center. Patients were predominately male (2.75:1). The mean age of onset was 65.9 years, and disease duration ranged from 2 months to 20 years. Diabetes was the most common comorbidity, and extremities were the most frequent sites of involvement. The lesions presented as papuloplaque, verrucous, cicatricial, targetoid, or mixed types. The dermoscopic features were variable, including red dots, white vague areas, black globules, and sand-like patterns. Among 10 Fonsecaea isolates further identified by sequencing the ITS regions of ribosomal DNA, nine were F. monophora and one was F. nubica. All but one patient received either systemic antifungal agents, surgical excision, or both. Surgical excision achieved a higher complete remission rate than the other forms of treatment did.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report.

Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance.

Chromomycosis, an unusual cause of cicatricial ectropion: a case report / Cromomicose como causa rara de ectrópio cicatricial: relato do caso

ABSTRACT Chromomycosis is a fungal infection that affects the epidermis, dermis, and subcutaneous tissue and is caused by dematiaceous fungal species that turn black on staining. We report the case of a 50-year-old male patient who was a rural worker and had been treated without success for three decades. Facial lesions progressed and caused severe cicatricial retraction. As the infection evolved, the left upper eyelid developed cicatricial ectropion. The surgical treatment was performed using skin obtained from the patient's own abdomen. Patient has developed a good postoperative appearance

RESUMO A cromomicose é uma infecção fúngica que afeta a epiderme, derme e tecido subcutâneo. A infecção é causada por espécies de fungo dematiáceos que se coram em preto. Nós relatamos o caso de um homen de 50 anos de idade, trabalhador da zona rural, que tinha sido tratado por três décadas sem êxito conclusivo. As lesões faciais progrediram causando retração cicatricial severa. Com a evolução do quadro, houve também retração também da pálpebra superior do olho esquerdo. O tratamento cirúrgico foi realizado utilizando pele abdominal do próprio paciente. O paciente apresentou uma boa aparência pós-operatória.

First reported Australian case of Cladophilophora arxii: features consistent with possible primary pulmonary chromoblastomycosis.

We describe the first case of possible pulmonary chromoblastomycosis in the absence of any identified cutaneous lesions in a relatively immunosuppressed man. The causative organism was Cladophialophora arxii, which is a rare pathogen that has only been described as causing human disease two times previously.

Presentación de un paciente con cromomicosis / Presentation of a Patient with Chromomycosis

La cromomicosis es una micosis subcutánea o profunda, de curso crónico, causada por un grupo de hongos, se caracteriza por la formación de nódulos cutáneos verrucosos, localizados comúnmente en miembros inferiores, de evolución crónica y difícil curación total. Se presentó un paciente de 34 años de edad, que hace cinco años le salieron placas (de tres a cuatro) dispuestas de forma lineal, aspecto papuloverrucoso en dorso del brazo izquierdo. Se indicó examen micológico, donde se informó la presencia Fonsecaea pedrosoi, para lo cual recibió tratamiento con fluconazol; por elevación de las transaminasas se interrumpió el tratamiento, luego se aplicó crioterapia y por último recibió tratamiento quirúrgico(AU)

Chromomycosis is a subcutaneous or deep mycosis of chronic course, caused by a group of fungi; it is characterized by the formation of coetaneous verrucous nodules, commonly located in lower limbs, of chronic evolution and total difficult cure. A 34- year-old patient that 5 years ago presented plaques (three-four) of lineal form, papulo verrucous in dorsum of the left arm, mycosis exam was indicated, and the diagnosis of Fonsecaea pedrosoiwas confirmed, treatment with fluconazol was given that was interrupted due to transaminase increase, thus cryotherapy was given and later surgical treatment(AU)

Cromomicosis: presentación de un paciente / Chromomycosis: presentation of a patient

La cromomicosis es una micosis subcutánea o profunda de curso crónico causada por un grupo de hongos dematiáceos que se caracteriza por la formación de nódulos cutáneos verrucosos y está localizada en zonas expuestas,fundamentalmente en los miembros inferiores y superiores. Se presenta un paciente masculino de 49 años de edad, piel blanca actínica, de profesión chofer de un camión de comunales, que desde el año 2010 presentaba una lesión en el dorso de la mano izquierda. Se le realizó un examen micológico con cultivo y se aisló la Phialophora verrucosa. Posteriormente la lesión se extendió a toda la mano, el antebrazo y la cara interna del brazo izquierdo. Fue ingresado en el Hospital Clínico Quirúrgico Arnaldo Milián Castro y se le aplicó un tratamiento antimicótico con anfotericín B endovenoso, previamente con ketoconazol y fluconazol, y finalmente tratamiento quirúrgico con exéresis y colgajos locales e injertos libres de piel; su evolución fue muy favorable y se encuentra en tratamiento de fisioterapia y rehabilitación(AU)

Challenges in the therapy of chromoblastomycosis.

Chromoblastomycosis (CBM) is an implantation mycosis mainly occurring in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM require long-term therapy with systemic antifungals flanked by various physical treatment regimens. As in other neglected endemic mycoses, comparative clinical trials have not been performed for this disease; nowadays, therapy is mainly based on a few open trials and on expert opinions. Itraconazole, either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been employed successfully in combination with antifungals in patients presenting with CBM. In the present paper, the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.

Chromoblastomycosis.

Chromoblastomycosis is a chronic, subcutaneous mycosis, characterized by verrucous nodular lesions, usually involving the legs and mainly caused by Fonsecaea, Phialophora, and Cladophialophora spp. The characteristic finding on direct examination or biopsy specimen is the presence of fumagoid cells or Medlar bodies. Chromoblastomycosis can be refractory to medical treatment. Therapeutic options include oral itraconazole, terbinafine, or 5-fluocytosine, alone or combined with surgery or cryosurgery.

A case of chromomycosis treated by surgical therapy combined with preceded oral administration of terbinafine to reduce the size of the lesion.

Chromomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous black fungi. Small lesions can be removed with excision, but other cases are difficult to treat. We report a case of chromomycosis caused by Fonsecaea pedrosoi (F. pedrosoi). The case involved a 74-year-old man, who had noted a lesion on the back of the right thigh, that was gradually enlarging and reaching up to 30 cm in diameter, in 20-years. From microscopic examination, sclerotic cells were seen. We diagnosed this case as chromomycosis caused by F. pedrosoi on mycological examination. The patient was initially treated with oral terbinafine (250 mg/day) as the lesion was very large. After the 18 months treatment, the size of the lesion reduced to 1 cm, then the remaining lesion was excised.

The clinical presentation and surgical treatment of verrucous dermatitis lesions in a draught horse.

Verrucous pastern dermatitis is a progressive inflammatory skin disease commonly involving the palmar or plantar aspects of the pasterns of horses. There are no reports of successful surgical treatment for multifocal circumscribed verrucous masses in the chronic stages of verrucous pastern dermatitis. A combination of sharp dissection and electrocautery was used to resect numerous multifocal circumscribed verrucous masses from the distal hindlimb of an 11-year-old gelding draught horse. There was no evidence of significant regrowth or complications at a 24 month postoperative examination.

Subcutaneous dematiaceous fungal infection.

Subcutaneous dematiaceous fungal infections, which include chromoblastomycosis and phaeohyphomycosis, are a heterogeneous group of clinical entities that are caused by dematiaceous or pigmented fungi found in soil. These infections have a wide spectrum of clinical presentations that depend largely on the specific causative organism and on the integrity of the host's immune response. Treatment is challenging and involves a highly individualized plan that often combines both surgical and long-term medical treatment.

Corneal chromoblastomycosis caused by Cladophialophora carrionii after cataract surgery.

We describe a case of corneal chromoblastomycosis with Cladophialophora carrionii in a 69-year-old woman 4 weeks after clear corneal cataract surgery. The patient presented with right eye pain and decreased visual acuity of 20/100. Examination showed a deep posterior stromal keratitis accompanied by a dense fibrinous anterior chamber reaction. An aqueous tap was performed, and the patient was treated with topical, systemic, and intracameral antifungal and antibiotic agents. The infection was resistant to medical therapy and the course further complicated by secondary pupillary block glaucoma. After 10 days, a therapeutic penetrating keratoplasty was performed. The patient remained asymptomatic 20 months after the initial presentation, with corrected distance visual acuity restored to 20/40. To our knowledge, is the first reported case of corneal chromoblastomycosis with C carrionii. Early surgical treatment may be necessary to eradicate Cladophialophora species.

Cladophialophora carrionii: an aetiological agent of cutaneous chromoblastomycosis from a non-endemic area, North India.

We present a case of infection due to Cladophialophora carrionii, an agent of Chromoblastomycosis in a 37-year-old Indian male. The patient developed a nodule as the lateral malleolus of his left leg. The lesion was successfully treated with surgical excision. Histopathologically, pigmented organisms were readily identified in tissue sections, and the cultural characteristics were these of Cladophialophora carrionii.

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.

Chromomycosis presenting as soft-tissue mass: report of a case with MRI features.

Chromomycosis is primarily a skin disease that superficially presents as slowly growing, verrucous lesions, often warty or cauliflower-like in appearance. It may occasionally create a flat, plaque-like lesion in the skin but deep-seated tumorous presentation has not previously been reported. As the lesion is limited to the cutaneous and superficial subcutaneous tissues, hitherto reported cases have been described from the view point of dermatology and, so, without MRI study. We report a patient with pathologically proven chromomycosis that produced a subcutaneous mass in the dorsum of the hand with an emphasis on MRI features.