Disseminated chromoblastomycosis: Diffuse truncal involvement with hematogenous spread

Abstract

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by one of the several species of dematiaceous fungi usually affecting the extremities and spreads by local inoculation and through lymphatics. A 27-year-old male alcoholic presented with a diffuse large polycyclic, indurated, verrucous crusted plaque covering the entire lower back of 6 months duration that gradually extended to involve the right flank and abdomen. Since 2 months, he developed extensive multiple discrete verrucous nodules with a crusted and scaly surface over the face and all extremities. Systemic examination revealed no abnormalities. Serum biochemistry profile and HIV screening revealed no abnormality. Histopathological examination demonstrated pseudoepitheliomatous hyperplasia, granulomatous reaction with foreign body giant cells, and scattered pigmented thick-walled yeast like cells in the dermis suggestive of chromoblastomycosis. Cultures on Sabouraud's dextrose agar grew dark greyish velvety fungal colonies that on microscopic examination revealed acropetal budding with oval-shaped conidia suggestive of Cladophialophora carrionii. We report the first case of chromoblastomycosis from the coastal region of Andhra Pradesh, who was immunosuppressed due to severe alcoholism and presented with extremely rare features of extensive truncal involvement and hematogenous dissemination.