Coexisting Chromoblastomycosis and Mycobacterium fortuitum Skin and Subcutaneous Infection

Abstract

We report a diabetic patient with coexisting skin and subcutaneous infection of chromoblastomycosis and Mycobacterium fortuitum. Cultures of these skin lesions or discharges frequently fail to demonstrate these organisms. Aggressive skin biopsy revealed finding and diagnosis of chromoblastomycosis and Mycobacterium fortuitum. We performed repeat skin biopsies and tissue cultures for this patient. The culture of right arm yielded Fonsecaea pedrosoi and the culture of left arm yielded Mycobacterium fortuitum. Preferred treatment is usually surgical excision or cryosurgery with liquid nitrogen for small lesions of chromoblastomycosis but we administered itraconazole 200 mg per day for 6 months and the lesions completely recovered with only the sequelae of pigmentation. The Mycobacterium fortuitum infection of left arm was cured with 8-month combination therapy of levofloxacin, clarithromycin, and 7-month treatment of amikacin. Duration of treatment depends on the clinical response and achievement of mycologic and histopathological cure.