Abstract
Chromoblastomycosis is a chronic and progressive recalcitrant fungal infection of the cutaneous and subcutaneous tissue caused by traumatic inoculation of a specific group of dematiacious fungi through skin. There are different treatment modalities for chromoblastomycosis (medical/surgical) having various efficacy. However, there is no treatment of choice for this disease. Though several therapeutic regimen has been proposed for almost 100 years, the disease may be recalcitrant and almost difficult to eradicate if diagnosed in later stage. Relapses are frequently reported. A combination of various treatment modalities is needed to achieve the best result.
 We report here a case of chromoblastomycosis in a 62-year-male who presented with verrucous nodules and plaques on right lower limb. The patient was unresponsive to oral itraconazole 400mg daily for 2 months but was subsequently treated with multiple serial sittings of surgical excision and carbon dioxide laser in combination with oral itraconazole over 6 months. This case report focuses on proper management and specifically on differential diagnoses and treatment modalities for chromoblastomycosis.
 Keywords: carbon dioxide laser; chromoblastomycosis; combination treatment.
Highlights
We report here a case of chromoblastomycosis in a 62-year-male who presented with verrucous nodules and plaques on right lower limb
Chromoblastomycosis (CBM) is a chronic and progressive recalcitrant fungal infection of the cutaneous and subcutaneous tissue caused by dematiaceous fungi.[1]
Though major advancement has been made in the epidemiology and employment of molecular methods in the taxonomy of etiologic agent, there is less scientific progress in the management and this disease still represents a true therapeutic challenge for clinicians.[2]
Summary
Chromoblastomycosis (CBM) is a chronic and progressive recalcitrant fungal infection of the cutaneous and subcutaneous tissue caused by dematiaceous fungi.[1]. The skin biopsies were sent for histopathology and tissue culture for fungus and AFB (Acid Fast Bacilli) stain for tuberculosis. Incisional biopsy from periphery of the lesion showed hyperkeratosis, epidermal hyperplasia, few intraepidermal neutrophilic abscess along with dense inflammatory infiltrates in upper dermis (plasma cells, eosinophils, lymphocytes & histiocytes.). In tissue culture for Acid Fast Bacilli, there was no growth after 8 weeks, AFB was negative. The treatment with oral itraconazole (ITZ) 400mg daily was initiated but after two months there was not much clinical improvement. Figure 1a: Before treatment showing erythematous, verrucous plaques and nodules extending from right mid-thigh to mid leg Figure 1b: Resolution of the initial lesion 6 months after treatment]. Figure 2a: Hyperkeratosis, epidermal hyperplasia, few intraepidermal neutrophilic abscess along with dense inflammatory infiltrates in upper dermis (Hematoxylin & eosin, X10). Figure 2b: showing Medlar bodies, few plasma cells, eosinophils, lymphocytes and histiocytes (Hematoxylin & eosin, X40)
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