Skip to main content Skip to main navigation menu Skip to site footer

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

  • Trisiswati Indranarum ,
  • Presstisa Gifta Axelia ,
  • Willy Sandhika ,
  • Muhammad Yulianto Listiawan ,
  • Evy Ervianti ,

Abstract

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.

References

  1. Brito AC De, Jesus M De, Bittencourt S. Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update. 2018;93(4):495–506.
  2. Queiroz-Telles F, Hoog S de, Santos DWCL, Salgado CG, Vicente VA, Bonifaz A, et al. Chromoblastomycosis. Clin Microbiol Rev. 2017;30(1):233–276.
  3. Santos DWCL, de Azevedo CMPES, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, et al. The global burden of chromoblastomycosis. PLoS Negl Trop Dis. 2021;15(8):1–26.
  4. Dong B, Liu W, Li R, Chen Y, Tong Z, Zhang X, et al. Muriform cells can reproduce by dividing in an athymic murine model of chromoblastomycosis due to fonsecaea pedrosoi. Am J Trop Med Hyg. 2020;103(2):704–712.
  5. Shen XC, Dai XN, Xie ZM, Li P, Lu S, Li JH, et al. A Case of Chromoblastomycosis Caused by Fonsecaea pedrosoi Successfully Treated by Oral Itraconazole Together with Terbinafine. Dermatol Ther (Heidelb). 2020;10(2):321–327.
  6. Queiroz-Telles F, de C L Santos DW. Challenges in the Therapy of Chromoblastomycosis. Mycopathologia. 2013;175(5–6):477–488.
  7. Mittal A, Agarwal N, Gupta LK, Khare AK. Chromoblastomycosis from a non-endemic area and response to itraconazole. Indian J Dermatol. 2014;59(6):606–608.
  8. da Silva Hellwig AH, Heidrich D, Zanette RA, Scroferneker ML. In vitro susceptibility of chromoblastomycosis agents to antifungal drugs: A systematic review. J Glob Antimicrob Resist. 2019;16:108–114.
  9. Queiróz AJR, Pereira Domingos F, Antônio JR. Chromoblastomycosis: clinical experience and review of literature. Int J Dermatol. 2018;57(11):1351–1355.
  10. Santos ALS, Palmeira VF, Rozental S, Kneipp LF, Nimrichter L, Alviano DS, et al. Biology and pathogenesis of Fonsecaea pedrosoi, the major etiologic agent of chromoblastomycosis. FEMS Microbiol Rev. 2007;31(5):570–591.
  11. Liu S, Zhi H, Shen H, Lv W, Sang B, Li Q, et al. Chromoblastomycosis: A case series from Eastern China. PLoS Negl Trop Dis. 2022;16(9):1–8.
  12. de Castro RJA, Siqueira IM, Jerônimo MS, Basso AMM, Veloso Junior PH de H, Magalhães KG, et al. The major chromoblastomycosis etiologic agent, Fonsecaea pedrosoi, activates the NLRP3 inflammasome. Front Immunol. 2017;8(11):1572.
  13. Antonello VS, Appel da Silva MC, Cambruzzi E, Kliemann DA, Santos BR, Queiroz-Telles F. Tratamento de cromoblastomicose severa com a associação itraconazole e 5-flucitosina. Rev Inst Med Trop Sao Paulo. 2010;52(6):329–331.
  14. Khadka DK, Pandey D, Agrawal S. Combination Treatment for Extensive Chromoblastomycosis: A Case Report. Nepal J Dermatology, Venereol Leprol. 2021;19(2):58–61.
  15. Lan Y, Lu S, Zhang J. Retinoid combined with photodynamic therapy against hyperkeratotic chromoblastomycosis: A case report and literature review. Mycoses. 2021;64(1):18–23.
  16. Lestari AAW, Prabawa IPY, Karyana IPSR, Wiranata S, Pramartha INT. The Role of Platelet-to-Mean Platelet Volume Ratio (PMPV-R) as Hematological Markers in Predicting Early Mortality Among Children with Sepsis. Indian Journal of Clinical Biochemistry. 2022;34(S1):S160-S160.
  17. Yolanda MO, Jusuf NK, Putra IB. Lower facial skin hydration level increases acne vulgaris severity level. Bali Medical Journal. 2021;10(3):1081–1084.
  18. Darmaputra IGN, Pramita IGAS, Winaya KK. Application of Moringa Oleifera leaves extract cream inhibits paw edema in white male Wistar rat (Rattus norvegicus) induced by carrageenan 1%. Bali Medical Journal. 2022;11(1):122–126.
  19. Sitepu EH, Muis K, Putra IB Dermatophytes and bacterial superinfections in tinea pedis patients at Haji Adam Malik Central Hospital, Medan-Indonesia. Bali Medical Journal. 2018;7(2):452-456.

How to Cite

Indranarum, T., Axelia, P. G., Sandhika, W., Listiawan, M. Y., & Ervianti, E. (2023). A case of chromoblastomycosis caused by Fonsecaea pedrosoi: challenge in diagnosis. Bali Medical Journal, 12(3), 3407–3410. https://doi.org/10.15562/bmj.v12i3.4836

HTML
5

Total
3

Share

Search Panel

Trisiswati Indranarum
Google Scholar
Pubmed
BMJ Journal


Presstisa Gifta Axelia
Google Scholar
Pubmed
BMJ Journal


Willy Sandhika
Google Scholar
Pubmed
BMJ Journal


Muhammad Yulianto Listiawan
Google Scholar
Pubmed
BMJ Journal


Evy Ervianti
Google Scholar
Pubmed
BMJ Journal