Case Of Chromoblastomycosis Research Articles

Pigmented fungus as a cause of chronic otitis externa: A rare case report

Abstract A sporadic infection by a pigmented fungus called chromoblastomycosis is seen in tropical and subtropical climates. It can affect lower extremities most commonly followed by upper extremities. Here, we report an unusual case of chromoblastomycosis causing otitis media in a young female. The ear is an uncommon site of involvement. She presented to the ear, nose, and throat outpatient department with a complaint of left earache for 1 week. On ear examination, the external auditory canal was occluded by debris. Debridement was done from the lesion and was sent for histopathological examination which revealed granulation tissue and fungal spores. Special stains were used to identify the fungus and the patient was treated with antifungals. We report this case to conclude that chromoblastomycosis though rare should be considered as one of the etiologies for otitis externa.

Deep Fungal Infections of Skin and Role of Histopathology in Diagnosis.

Deep mycoses acquired by penetrating trauma to the skin can have varied and sometimes atypical morphological presentations resulting in diagnostic dilemmas and delay in treatment onset. Histopathology can be a useful tool in not only diagnosing but also differentiating various deep mycoses. To observe various morphological presentations and histopathological features of deep fungal infections. A retrospective multi-centric study was conducted from 2010 to 2020 at 16 centres. The cases with diagnoses of various deep mycoses were included in the study. The patients presenting with cutaneous manifestations were included in the study. Their demographic details, history, presenting signs and symptoms, morphological presentations, histopathological features and treatment details were collected from the case sheets. A total of 124 cases were found from the case records. The most common type was chromoblastomycosis (42) followed by mycetoma (28) and rhinosporidiosis (17). The mean age was 43.76 ± 5.44 years. The average duration of symptoms before presentation was between 2 months to 10 years (average 2.5 ± 1.33 years). Male to female ratio was 1:0.7. Prior history of trauma was recorded in 36% of cases. Chromoblastomycosis cases presented with verrucous to atrophic plaques with black dots on the surface and histopathology findings included pesudoepitheliomatous hyperplasia, epithelioid cell granulomas, copper penny bodies within granulomas and abscesses. Rhinosporidiosis cases had polypoid grape-like lesions in the nose and eyes most commonly with histopathology findings of abundant thick-walled sporangia in dermis packed with thousands of spores. Eumycetoma patients had pigmented, indurated swelling with multiple sinuses discharging black granules and histopathology showed dermal abscesses and foreign body granulomatous reaction with PAS-positive hyphae. Histoplasmosis patients presented with few to multiple nodulo-pustular lesions on skin and palatal ulcers while small basophilic bodies packed in the cytoplasm of histiocytes were noted in histopathology. Phaeohyphomycosis cases presented as deep-seated cystic lesions and biopsy revealed deepithelialized cysts in the dermis or hypodermis with lumen showing necro inflammatory debris and fungal hyphae. Sporotrichosis cases had erythematous, tender nodules and papules either as single lesions or as multiple lesions arranged in a linear fashion and histopathology showed pseudoepitheliomatous hyperplasia of epidermis, loose to well-defined epithelioid cell granulomas and microabscesses. Spores were found in two cases. Cryptococcosis patient had multiple umbilicated lesions resembling giant molluscum contagiosum loose epithelioid cell granulomas and medium-sized spores lying in both intra and extracellularly on histopathology. Penicilliosis patients had nodulo-pustular lesions and histopathology showed an admixture of histiocytes, epithelioid cells, plasma cells, lymphocytes and polymorphs in the dermis with the presence of yeast-like spores in the cytoplasm of histiocytes and epithelioid cells. Entomophthoromycosis cases presented with asymptomatic subcutaneous firm swelling with loss of skin pinchability. Though clinical findings of deep fungal infections are characteristic similar morphology and atypical presentations can be sometimes confusing. Histopathology is useful for confirming the diagnosis.

From diagnosis to treatment- Navigating Chromoblastomycosis

Chromoblastomycosis is a chronic fungal skin infection caused by dematiaceous fungi, characterized by nodular skin lesions and the presence of sclerotic bodies in affected tissues. Here, we report a case of chromoblastomycosis from Karnataka, India. A 22 years old female patient presented with a history of a vegetating ulcer with crusting. The diagnosis of chromoblastomycosis was made by demonstration of sclerotic bodies on histopathology of the biopsy specimen. Presence of pigment, multinucleate giant cells and eosinophils were the clues to search for the dematacious fungi on histopathology. High degree of suspicion by the clinician and the pathologist is important for definitive diagnosis.

Clinicopathological study of pigmented fungal lesions with special reference to subcutaneous phaeohyphomycosis: A 3-year study in a tertiary care hospital of Eastern India

Background: Fungal infections are predominantly opportunistic infections in immunocompromised patients and in immunocompetent adults with a history of trauma. Recently, there is an increase in trends of fungal infections in immunocompetent individuals also without any history of trauma. Pigmented fungi are a group of fungi that have pigment in their cell wall and also known as dematiaceous fungi. These pigmented fungi include phaeohyphomycosis with a differential diagnosis of chromoblastomycosis, cryptococcosis, mycetoma, and aspergillus. Phaeohyphomycosis is a subcutaneous or systemic infection characterized histologically by dark-colored fungal hyphae and yeast forms (black yeast). Aims and Objectives: The aim of the present study is to analyze the clinicopathological features of pigmented fungal infections in biopsy specimen based on their histomorphology. Materials and Methods: This was a prospective study in which we have analyzed the dematiaceous fungal species by their histomorphological characteristics in biopsy specimens. Results: A total of 21 cases of biopsy specimens (with the clinical presentation of cutaneous/subcutaneous lesions) were studied histologically which showed 13 cases of phaeohyp homycosis, seven cases of eumycotic mycetoma, and one case of chromoblastomycosis. There was male predominance (17, 80.95%) and the majority of the patients were >60 years (16, 76.19%). Most common site of infection was foot with predominant clinical presentation as subcutaneous mass lesion. Conclusion: All the cases of dematiaceous fungal infections were diagnosed by histopathological examination. Melanin in the cell wall of dematiaceous fungi is the pathogenic factor. Phaeohyphomycosis is no longer considered as a rare infection rather there is an increasingly incidence of recognized infection. Although culture and histopathological study remain important tools for final diagnosis, various molecular studies might be helpful for accurate diagnosis.

A case of chromoblastomycosis caused by Fonsecaea pedrosoi: challenge in diagnosis

Link of Video Abstract: https://youtu.be/9CxOCuDn4f4 Background: Chromoblastomycosis (CBM) is a chronic, granulomatous mycosis of the skin and subcutaneous tissue produced by the traumatic inoculation of various dematiaceous fungi. CBM lesions are clinically polymorphic and often misdiagnosed as multiple infectious and noninfectious diseases. Early diagnosis and prompt treatment of CBM are important to prevent further complications. This case study aims to evaluate the chromoblastomycosis caused by Fonsecaea pedrosoi as a challenge in diagnosis. Case Presentation: A male, 47 years old, came to the dermatovenereology clinic with a chief complaint of a wound on his right leg 17 years ago. The skin appeared thicker and scaly and felt rough. He also complained of pain and itch on the wound. Dermatological examination revealed multiple verrucous erythematous plaques, sized 10x20 cm, irregular with a well-defined and elevated border and black punctum. Results of potassium hydroxide, culture, and histopathology examination confirmed CBM with F. pedrosoi as the etiological agent. The patient was treated with a favorable outcome with oral itraconazole, local thermotherapy, and CO2 laser. Conclusion: The diagnosis of Chromoblastomycosis remains a challenge because lesions are clinically polymorphic and often misdiagnosed as various infectious and noninfectious diseases. Physicians should raise awareness of CBM as one of the differential diagnoses for chronic wounds. This case also showed that the combination treatment of itraconazole with adjuvant thermotherapy and CO2 laser had a favorable outcome.

Tratamento bem-sucedido da cromoblastomicose pela associação entre criocirurgia e itraconazol em dose baixa

Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug.

A CLINICO INVESTIGATIVE AND MYCOPATHOLOGICAL PROFILE OF FUNGI CAUSING SUBCUTANEOUS INFECTIONS IN A TERTIARY CARE HOSPITAL

Background & Objectives: Subcutaneous mycoses comprise a heterogeneous group of fungal infection. They are characterized by development of lesions at the site of inoculation of fungi in the subcutaneous tissues. Immunocompromised patients are at increased risk of infections. The main subcutaneous mycoses are Mycetoma, Chromoblastomycosis, Phaeohyphomycosis, Sporotrichosis followed by Rhinosporidiosis, Subcutaneous phycomycosis and lacaziosis. This study was planned with the aim of determining the prevalence, etiological agents of subcutaneous mycoses and their Clinicopathological profile. Materials And Methods: A total of 40 consecutive patients with clinically suspected subcutaneous mycoses attending various departments of Govt. Stanley Medical College and Hospital were included in this Cross sectional study. Fungi were identified by Direct microscopy in 10 and 40 % KOH, histopathological examination of biopsied tissue, colony characteristics on Sabourauds dextrose agar media both at 25 and 37 °C and detailed morphology of each fungus on Lactophenol cotton blue mount. Results: The percentage of Subcutaneous mycoses among fungal infections was 2.11%. Of the 40 cases of subcutaneous mycoses, 16 cases of Phaeohyphomycosis (40%), 12 cases of Mycetoma (30%), 10 cases of Chromoblastomycosis (25%) and 2 cases of Rhinosporidiosis (5%) were identified. In this study, 14 different species of fungus were found to be responsible for subcutaneous infections. Interpretation &Conclusion: The prevalence of Subcutaneous mycoses in this region is 2.11% of total fungal cases. Higher incidence of infections were noticed in the age group of 41-60. Comorbidities plays a crucial role in disease progression. Clinical suspicion, early laboratory confirmation of diagnosis and appropriate treatment is crucial in these infections. Clinicians must be aware of the clinical presentations of subcutaneous mycoses. Timely diagnosis will prevent chronic morbidity in patients.

Assorted copper pennies on a scar - a case of chromoblastomycosis after knee transplant

Assorted copper pennies on a scar - a case of chromoblastomycosis after knee transplant

New possibilities for chromoblastomycosis and phaeohyphomycosis treatment: identification of two compounds from the MMV Pathogen Box® that present synergism with itraconazole.

BACKGROUND Black fungi of the Herpotrichiellaceae family are agents of chromoblastomycosis and phaeohyphomycosis. There are few therapeutic options for these infections and it is common to associate antifungal drugs in their treatment.OBJECTIVES To investigate the Medicines for Malaria Venture (MMV) Pathogen Box® for possible compounds presenting synergism with antifungal drugs used to treat black fungal infections.METHODS An initial screening of the Pathogen Box® compounds was performed in combination with itraconazole or terbinafine at sub-inhibitory concentrations against Fonsecaea pedrosoi. Hits were further tested against eight Herpotrichiellaceae using the checkerboard method.FINDINGS No synergism was observed with terbinafine. MMV687273 (SQ109) and MMV688415 showed synergism with itraconazole against F. pedrosoi. Synergism of these compounds was confirmed with some black fungi by the checkerboard method. SQ109 and itraconazole presented synergism for Exophiala dermatitidis, F. pedrosoi, F. monophora and F. nubica, with fungicidal activity for F. pedrosoi and F. monophora. MMV688415 presented synergism with itraconazole only for F. pedrosoi, with fungicidal activity. The synergic compounds had high selectivity index values when combined with itraconazole.MAIN CONCLUSIONS These compounds in combination, particularly SQ109, are promising candidates to treat Fonsecaea spp. and E. dermatitidis infections, which account for most cases of chromoblastomycosis and phaeohyphomycosis.

Combination Treatment for Extensive Chromoblastomycosis: A Case Report

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.

Clinicopathological Analysis of Fungal Lesions with Unique Presentations in Immunocompetent Adults – A Case Series from a Tertiary Care Hospital in North Karnataka

Introduction: Fungal infections are mostly an opportunistic infection in immunocompromised patients and posttraumatic in immunocompetent adults. However, there has been a recent increasing trend of cases among immunocompetent adults with no history of trauma. Very few case series describing the clinicopathological picture of prevalent fungi are available from the various regions of India. Aims and Objectives: The present study aims to analyze clinicopathological features of various cases of fungal etiology with unique or rare presentations. Materials and Methods: This study included a clinicopathological analysis of surgical specimens received for histopathological examination at our hospital with special emphasis on cases with rare or unique presentations during the 1-year period from June 2019 to June 2020. Results: A total of 11 cases of fungal lesions with rare or unique clinicopathological presentations were selected for analysis. Majority of the patients were male, and most of them were from a rural background. There were four cases of aspergillosis, two cases of fungal keratitis, one case of renal aspergillosis, and one case of a subcutaneous swelling with discharging sinus. There were three cases of chromoblastomycosis, which presented as subcutaneous swellings with no lesion of overlying skin. There was an incidental finding of Candida sp. in two esophageal endoscopic biopsies, which primarily revealed esophageal adenocarcinoma. There was one case each of eumycetoma and mucormycosis. However, the mucormycosis case occurred in the setting of fungal abscess with osteomyelitis of the left mandible. Conclusion: Fungal lesions have revealed an increasing trend of infections in immunocompetent individuals in recent years, with various unique clinicopathological presentations. Therefore, there is a need for increased vigilance and analysis of such cases.

A STUDY ON CHROMOBLASTOMYCOSIS IN A TERTIARY CARE HOSPITAL (DMCH), LAHERIASARAI, BIHAR

Background: Chromoblastomycosis, a chronic subcutaneous mycosis, is caused by several dematiaceous Fungi, the most common being Fonsecaea pedrosoi. A majority of cases from India have been reported from the sub-Himalayan belt and South India. Aim: The aim was to study chromoblastomycosis in around Darbhanga reason of Bihar including demographic and clinicomycological prole. Materials and Methods: This report is a retrospective hospital record-based analysis of all cases of chromoblastomycosis who presented to the dermatology outpatient department of our tertiary care hospital during the past 3 years. Results : A total of 11 cases of chromoblastomycosis were diagnosed during the above period. The disease was seen predominantly in middle-aged male. The lower extremity (72.7%) was more commonly affected. Verrucous and nodular lesions are the common clinical presentation. Sclerotic bodies are demonstrated in potassium hydroxide mount and histopathological section in 81.8% and 90.9% cases, respectively. The causative fungus was isolated in 90.9% and cass with F. pedrosoi, as the most common species

An Urban Case of Chromoblastomycosis in the United States

Rash is a common chief complaint in the emergency room. Infection and pathogen colonization of the skin are among the most common causes of rash. Workers throughout the world are occupationally exposed to fungal species, increasing the likelihood of infection. Chromoblastomycosis is a common tropical infection found in workers exposed to the fungal species Fonsacaea and Cladophialophora. Although rarely seen in the United States, some cases of chromoblastomycosis have been reported. Presentations in immunocompetent patients primarily involve dermal infections. Long-term treatment is required to avoid complications related to untreated infection. Our case presents an elderly immunocompetent patient who emigrated from an endemic region in Asia and presented with chromoblastomycosis. This case highlights the importance of internists recognizing a locally rare but treatable condition.

Chromoblastomycosis Caused by Phialophora—Proven Cases from Mexico

Chromoblastomycosis is a chronic severely mutilating disease caused by fungi of the order Chaetothyriales. Classically, Phialophora verrucosa has been listed among these etiologic agents. This species is known to occur in the environment and has been found to cause other infections like phaeohyphomycosis, while reported cases of chromoblastomycosis are scant. Phialophora is phylogenetically diverse, and thus retrospective confirmation of etiology is necessary. We studied ten proven cases of chromoblastomycosis from Mexico and further analyzed the population genetics and genomics of the Phialophora species to understand their pathogenicity and predilection. The clinical strains were molecularly identified as Phialophora americana (n = 4), Phialophora chinensis (n = 4), and Phialophora macrospora (n = 2). No genetic distinction between clinical and environmental strains was possible. Further analysis of strains from diverse origins are needed to address eventual differences in virulence and niche predilection between the species.

Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review

Chromoblastomycosis (CBM) is a chronic granulomatous fungal infection caused by melanised or brown-pigmented fungi. It can lead to chronic persistent infections and may cause incapacity for labour in some severe clinical forms. The optimal therapy for CBM is still uncertain. Here, we reported the case of a 66-year-old male who has had red plaque and recurrent keratinised protrusions on his right forearm for 20years. He was treated orally with terbinafine, itraconazole and isotretinoin. He also received carbon dioxide(CO2 ) laser to eradicate the keratinised protrusions and promote the penetration of photosensitiser. After the CO2 laser, 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) was adopted immediately to inhibiting the growth of fungi in subcutaneous tissue. The patient received an important improvement with a plaque and crust reduction after 4months. For such recalcitrant case of chromoblastomycosis, the use of retinoid, CO2 laser combined with ALA-PDT may be a new adjuvant therapy. We further reviewed the cases of chromoblastomycosis treated with laser, photodynamic therapy or retinoic acid.

Molecular identification of environmental dematiaceous fungi isolates from Babol city, north of Iran

Background & aimChromoblastomycosis is a chronic, progressive cutaneous and subcutaneous fungal infection clinically manifested by nodular, crusted and verrucose lesions appearing as a result of tissue proliferation around the site of traumatic inoculation of the exosaprophytic pigmented fungi. Up to now, little studies available documenting the presence of these organisms from environmental sources in Iran. Therefore, this study was aimed to investigate the presence of black fungi in the nature of Iran. Methods and materialsA total of 400 environmental samples including: air, soil, wood, plant matters, grain and organic debris were obtained from different areas (public places) belonging to Babol city of the Mazandaran province in north of Iran during one year. The grown dark colonies were then isolated and exposed to DNA extraction. All culture positive isolates were identified to the species level by DNA sequencing of ITS1–5.8S–ITS2 rDNA region. ResultsBased on morphological appearances, 79 strains of dematiaceous fungi including 13 genera and 23 species were isolated from 400 included samples. Cladosporium herbarum (17/79) was the most predominantly identified species, afterward Alternaria spp., Curvularia spp. and Ulocladium spp. in descending frequency isolated as well. Summer season was documented as the time of highest fungal isolation rate. ConclusionAlthough, all the environmental black fungi isolated strains from current study are regarded as nonpathogenic. However, the rise in the reports of chromoblastomycosis cases in both healthy and immunocompromised hosts, caused by these fungi that gain entrance through the skin by traumatic implantation of natural sources, all over the world is alarming.

A Case of Chromoblastomycosis Caused by Fonsecaea pedrosoi Successfully Treated by Oral Itraconazole Together with Terbinafine.

Patients with chromoblastomycosis (CBM) usually have a history of local skin damage related to outdoor activities, mainly manifested as chronic refractory proliferative pathologic changes. We report a case of a 56-year-old man with CBM, identified as Fonsecaea pedrosoi infection by fungal culture and gene sequencing. This patient was successfully treated with a regimen of oral itraconazole (ITZ) and terbinafine lasting 7 months. Through in vitro drug sensitivity tests, minimum inhibitory concentrations of amphotericin, ITZ, and terbinafine were 1 μg/ml, 0.25 μg/ml, and 1 μg/ml, respectively. In this case, terbinafine was found to be more effective than ITZ.

Chromoblastomycosis: A rare fungal infection from a nonendemic region—Southern Odisha

Chromoblastomycosis, a slowly progressing localized fungal infection confined to the skin and subcutaneous tissue, is caused by dematiaceous fungi. Dermal lesions are pleomorphic and can range from small nodules to large papillary like eruptions. Herein, we report a case of chromoblastomycosis in a 26-year-old male caused by Fonsecaea pedrosoi. The patient was immunocompetent and had thorn injury 4 years back and developed a nonhealing ulcer on the medial aspect of his right leg, which was clinically suspected as tuberculous or carcinomatous lesion. Punch biopsy was done and sent in normal saline for the histopathological examination. Microscopically, sclerotic bodies, characteristic of chromoblastomycosis, were noticed on hematoxylin and eosin stained sections. Potassium hydroxide mount of the punch biopsy also revealed dematiaceous branching septate fungal hyphae. The fungal culture produced typical black colonies of Fonsecaea pedrosoi. The case is of interest because to the best of our knowledge it has so far not been reported from our region—southern part of Odisha.

A case of chromoblastomycosis in maxillary sinuses

Introduction: Chromoblastomycosis is a chronic skin and subcutaneous mycotic infection caused by pigmented or dematiaceous saprophytic fungi. The most common sites being upper and lower extremities following any trauma. This paper reports a rare case of chromoblastomycosis in maxillary sinus. Case Report: The patient was a 34 years old farmer who presented with nasal discharge and epistaxis for the last 15 days. Following examination, the polyp was excised and sent for histopathological examination which was diagnosed as chromoblastomycosis. Conclusion: Chromoblastomycosis presenting as a nasal mass is a very rare entity and is usually mistaken for granulomatous conditions. Histopathological examination along with culture for fungal organisms could aid in the detection of species and effective management. Keywords: Chromoblastomycosis, Maxillary sinus, Copperpennies, Medlar bodies.

Long-pulsed 1064 nm Nd: YAG laser combined with terbinafine against chromoblastomycosis caused by Fonsecaea nubica and the effect of laser therapy in a Wistar rat model

We report a case of chromoblastomycosis caused by Fonsecaea nubica, which was successfully treated by long-pulsed 1064 nm Nd: YAG laser combined with terbinafine. A 60-year-old man was admitted for the presence of a 30 mm×40 mm erythematous plaque on the dorsum of his right hand for about 10 months without any subjective symptoms. Both microscopic examination and tissue biopsy of the lesion showed characteristic sclerotic bodies of chromoblastomycosis. Lesion tissue culture on SDA at 26 ℃ for 2 weeks resulted in a black colony, and slide culture identified the isolate as Fonsecaea species. ITS sequence analysis of the isolate showed a 99% homology with F. nubica strain KX078407. The in vitro susceptibility of the isolate to 9 antifungal agents was determined using the microdilution method according to the guidelines of CLSI M38-A2 protocol, and terbinafine showed the lowest MIC (0.125 μg/ml). We subsequently established a Wistar rat model of chromoblastomycosis using the clinical isolate F. nubica and treated the rats with long-pulsed 1064 nm Nd: YAG laser (pulse width of 3.0 ms, fluence of 24 J/cm2, spot size of 3 mm, frequency of 4 Hz, repeated 3 times at an interval of 30 s) twice a week for a total of 8 sessions. Although the laser treatment alone was not able to eliminate the fungi, histopathological examination showed the aggregation of numerous lymphocytes in the local affected tissue, indicating an immune response that consequently facilitate the regression of the lesion. The patient was successfully treated by long-pulsed 1064 nm Nd: YAG laser once a week combined with terbinafine (0.25 /bid) for 8 weeks, and follow-up for 20 months did not reveal any signs of recurrence.