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Dermatology
Nodular lesions of the buttock for 20 years: the challenge of chromoblastomycosis in non-endemic settings
  1. William Osborne1,
  2. Gerald Langman2,
  3. Evmorfia Ladoyanni3 and
  4. Amy Chue1
  1. 1Infectious Diseases & Tropical Medicine, Heartlands Hospital, Birmingham, UK
  2. 2Pathology, Heartlands Hospital, Birmingham, UK
  3. 3Dermatology, Solihull Hospital, Solihull, UK
  1. Correspondence to Dr Amy Chue; amy.chue2{at}uhb.nhs.uk

Abstract

Chromoblastomycosis is an implantation mycosis of the skin caused by certain species of melanised fungi. A man in his 50s, born in Kerala but living in England for 14 years, presented with a nodular lesion on his left buttock, which had been present for 20 years. Biopsy revealed muriform cells and fungal culture isolated Fonsecaea spp, consistent with a diagnosis of chromoblastomycosis. Treatment with oral terbinafine was initiated and changed to itraconazole based on results of antifungal susceptibility. Drug intolerance and low drug levels of itraconazole necessitated change to voriconazole and topical terbinafine. Despite long-term combined therapy, the lesions worsened, and the patient opted for surgical excision abroad. Recurrence was evident at surgical sites and combined therapy continues. Chromoblastomycosis is an insidious and burdensome neglected tropical disease. Within non-endemic countries, diagnosis remains challenging. A travel history and appropriate fungal investigations are vital.

  • Dermatology
  • Infections
  • Tropical medicine (infectious disease)

https://doi.org/10.1136/bcr-2023-258097

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: WO, AC. The following authors gave final approval of the manuscript: WO, GL, EL, AC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.