Abstract

Case Report

Rare Presentation of Chromoblastomycosis Due to Multiple Simultaneous Inoculations: A Case Report

Walter Belda Jr* and Luiz Felipe Passero

Published: 07 August, 2023 | Volume 7 - Issue 1 | Pages: 032-035

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface.
The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.

Read Full Article HTML DOI: 10.29328/journal.adr.1001028 Cite this Article Read Full Article PDF

Keywords:

Chromoblastomycosis, Treatment, Rare Presentation, Multiple Inoculations

References

  1. Queiroz-Telles F. CHROMOBLASTOMYCOSIS: A NEGLECTED TROPICAL DISEASE. Rev Inst Med Trop Sao Paulo. 2015 Sep;57 Suppl 19(Suppl 19):46-50. doi: 10.1590/S0036-46652015000700009. PMID: 26465369; PMCID: PMC4711190.
  2. Guevara A, Siqueira NP, Nery AF, Cavalcante LRDS, Hagen F, Hahn RC. Chromoblastomycosis in Latin America and the Caribbean: Epidemiology over the past 50 years. Med Mycol. 2021 Dec 8;60(1):myab062. doi: 10.1093/mmy/myab062. PMID: 34637525.
  3. López Martínez R, Méndez Tovar LJ. Chromoblastomycosis. Clin Dermatol. 2007 Mar-Apr;25(2):188-94. doi: 10.1016/j.clindermatol.2006.05.007. PMID: 17350498.
  4. Tele J, Gupta S, Patil N. Cutaneous chromoblastomycosis-unusual presentation: a case report. Int J Res Med Sci, 2018;6:2856-2859
  5. Belda W, Carvalho CHC, Passero LFD. Chromoblastomycosis with 18 years of evolution. Int J Res Med Sci. 2023 Aug;11(8):3034-3038
  6. de Almeida Júnior JN, Figueiredo DS, Toubas D, Del Negro GM, Motta AL, Rossi F, Guitard J, Morio F, Bailly E, Angoulvant A, Mazier D, Benard G, Hennequin C. Usefulness of matrix-assisted laser desorption ionisation-time-of-flight mass spectrometry for identifying clinical Trichosporon isolates. Clin Microbiol Infect. 2014 Aug;20(8):784-90. doi: 10.1111/1469-0691.12502. Epub 2014 Jan 16. PMID: 24355037.
  7. de Almeida JN Jr, Favero Gimenes VM, Francisco EC, Machado Siqueira LP, Gonçalves de Almeida RK, Guitard J, Hennequin C, Colombo AL, Benard G, Rossi F. Evaluating and Improving Vitek MS for Identification of Clinically Relevant Species of Trichosporon and the Closely Related Genera Cutaneotrichosporon and Apiotrichum. J Clin Microbiol. 2017 Aug;55(8):2439-2444. doi: 10.1128/JCM.00461-17. Epub 2017 May 24. PMID: 28539340; PMCID: PMC5527422.
  8. Brito AC, Bittencourt MJS. Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update. An Bras Dermatol. 2018 Jul-Aug;93(4):495-506. doi: 10.1590/abd1806-4841.20187321. PMID: 30066754; PMCID: PMC6063100.
  9. de Andrade TS, de Almeida AMZ, Basano SA, Takagi EH, Szeszs MW, Melhem MSC, Albuquerque M, Camargo JSAA, Gambale W, Camargo LMA. Chromoblastomycosis in the Amazon region, Brazil, caused by Fonsecaea pedrosoi, Fonsecaea nubica, and Rhinocladiella similis: Clinicopathology, susceptibility, and molecular identification. Med Mycol. 2020 Feb 1;58(2):172-180. doi: 10.1093/mmy/myz034. PMID: 31329924.
  10. Schwalb A, Seas C. Chromoblastomycosis. N Engl J Med. 2020 Jul 9;383(2):e7. doi: 10.1056/NEJMicm1913199. PMID: 32640136.
  11. Baka JLCES, Giraldelli G, Bernardes-Engemann AR, Barcaui CB, Orofino-Costa R. Urban chromoblastomycosis: a diagnosis that should not be neglected. An Bras Dermatol. 2023 May-Jun;98(3):422-425. doi: 10.1016/j.abd.2022.01.013. Epub 2023 Feb 4. PMID: 36746731; PMCID: PMC10173060.
  12. Castro LG, Andrade TS. Chromoblastomycosis: still a therapeutic challenge. ExpertRev Dermatol. 2010; 5:433-443.
  13. Martinez RL, Tovar LJ. Cromoblastomycosis. Clin Dermatol. 2007; 25:188-194.
  14. Seas C, Legua P. Mycetoma, chromoblastomycosis and other deep fungal infections: diagnostic and treatment approach. Curr Opin Infect Dis. 2022 Oct 1;35(5):379-383. doi: 10.1097/QCO.0000000000000870. Epub 2022 Aug 3. PMID: 35942857.
  15. Azevedo Cde M, Marques SG, Resende MA, Gonçalves AG, Santos DV, da Silva RR, de Sousa Mda G, de Almeida SR. The use of glucan as immunostimulant in the treatment of a severe case of chromoblastomycosis. Mycoses. 2008 Jul;51(4):341-4. doi: 10.1111/j.1439-0507.2007.01485.x. Epub 2008 Apr 28. PMID: 18444974.
  16. de Sousa Mda G, Belda W Jr, Spina R, Lota PR, Valente NS, Brown GD, Criado PR, Benard G. Topical application of imiquimod as a treatment for chromoblastomycosis. Clin Infect Dis. 2014 Jun;58(12):1734-7. doi: 10.1093/cid/ciu168. Epub 2014 Mar 14. PMID: 24633683; PMCID: PMC4036686.
  17. Belda W Jr, Criado PR, Passero LFD. Successful treatment of chromoblastomycosis caused by Fonsecaea pedrosoi using imiquimod. J Dermatol. 2020 Apr;47(4):409-412. doi: 10.1111/1346-8138.15225. Epub 2020 Jan 21. PMID: 31960479.
  18. Belda W, Criado PR, Domingues Passero LF. Case Report: Treatment of Chromoblastomycosis with Combinations including Acitretin: A Report of Two Cases. Am J Trop Med Hyg. 2020 Nov;103(5):1852-1854. doi: 10.4269/ajtmh.20-0471. PMID: 32815507; PMCID: PMC7646813.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Similar Articles

Recently Viewed

  • Why Down-managing Backlog Forensic DNA Case Entries Matters
    JH Smith* and JS Horne JH Smith*, JS Horne. Why Down-managing Backlog Forensic DNA Case Entries Matters. J Forensic Sci Res. 2024: doi: 10.29328/journal.jfsr.1001056; 8: 001-008
  • Scintigraphic non-invasive diagnosis of amyloid cardiomyopathy
    Laroussi Mohamed-Salem*, Tomás E Rodríguez-Locarno, Tatiana Moreno-Monsalve, Isabel Castellón-Sánchez, José F Contreras-Gutiérrez and Antonia Claver-Valderas Laroussi Mohamed-Salem*,Tomás E Rodríguez-Locarno,Tatiana Moreno-Monsalve,Isabel Castellón-Sánchez,José F Contreras-Gutiérrez ,Antonia Claver-Valderas. Scintigraphic non-invasive diagnosis of amyloid cardiomyopathy. J Cardiol Cardiovasc Med. 2019: doi: 10.29328/journal.jccm.1001058; 4: 156-158
  • Anomalies of coronary artery origin: About two cases
    Dioum M*, Sarr EM, Manga S, Mingou JS, Diack A, Diop AD, Bindia D, Diagne PA, Sarr AN and Diop IB Dioum M*,Sarr EM,Manga S,Mingou JS,Diack A,Diop AD,Bindia D,Diagne PA,Sarr AN,Diop IB. Anomalies of coronary artery origin: About two cases. J Cardiol Cardiovasc Med. 2019: doi: 10.29328/journal.jccm.1001051; 4: 117-119
  • Late discover of a traumatic cardiac injury: Case report
    Benlafqih C, Bouhdadi H*, Bakkali A, Rhissassi J, Sayah R and Laaroussi M Benlafqih C,Bouhdadi H*,Bakkali A,Rhissassi J,Sayah R,Laaroussi M. Late discover of a traumatic cardiac injury: Case report. J Cardiol Cardiovasc Med. 2019: doi: 10.29328/journal.jccm.1001048; 4: 100-102
  • Severe Infantile Coarctation and Mid Aortic Stenosis in Williams Syndrome
    Lousararian Marina, Troglia Ana, Cabrera María J and Alday Luis E* Lousararian Marina,Troglia Ana,Cabrera María J,Alday Luis E*. Severe Infantile Coarctation and Mid Aortic Stenosis in Williams Syndrome. J Cardiol Cardiovasc Med. 2019: doi: 10.29328/journal.jccm.1001044; 4: 080-082

Read More

Most Viewed

Read More

Help ?