We report herein a case of chromoblastomycosis caused by Fonsecaea (F.) pedrosoi in a year-old male, who showed multiple, asymptomatic, scaly. Species name and common name: Fonsecaea pedrosoi complex which includes F. monophora and the previously named species F. compacta, now. Fonsecaea pedrosoi (Brumpt) Negroni, Rev. Inst. Bact.: () [MB#].
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We report herein a case of chromoblastomycosis caused by Fonsecaea F. Histopathologically, chronic granulomatous inflammation and either sclerotic or muriform cells were observed.
The fungal culture produced typical black colonies of F. The patient was treated with mg of itraconazole daily, for 3 months. Skin lesions were improved.
In Korea, only 9 cases of chromoblastomycosis, including this case, have been reported until now. The etiologic agent was F.
The incidence of chromoblastomycosis was slightly higher in female, and the upper limbs were more affected than the lower limbs in patients. Chromoblastomycosis is a chronic fnosecaea caused by saprophagous dematiaceous fungi, when it enters through an open wound and infects both skin and subcutaneous tissue. This disease is mostly reported in tropical and subtropical areas and is often caused by Fonsecaea F.
Other lesser etiologic agents are Cladosporium Cladophialophora carrioniiPhialophora verrucosaRhinocladiella aquaspersaF. This rare skin disease, caused by fungus profundus, is rarely reported in Korea, compared to Japan 4 – 7even though these two countries are in the same Northeast Asia region. In Korea, clinical and histological findings have led to diagnosis of this disease by Ahn and Fonsecxea 8 in Since the first identification of the etiologic agent by Suh et al.
Therefore, we present herein the case of a year-old male patient who developed multiple erythematous plaques on the left lower leg. Clinical and histopathological findings, as well as fungus culture, light microscope findings and molecular biological analysis, have led us to diagnose the patient with chromoblastomycosis, caused by F.
The findings were presented with a review of the literature and previous reports of chromoblastomycosis in Korea. A year-old male presented with scaly erythematous plaque, with ulceration on the left shin Fig.
Fonsecaea pedrosoi – Wikipedia
He was a Thai worker living in Korea, and without specific traumatic event, he had the asymptomatic eythematous papule for 12 months. The patient had history of visiting Thailand 15 months ago. The lesion gradually increased in size fonsecada eventually developed into ulcerative erythematous plaque. His past medical history and family history was unremarkable.
On physical examination, the general physical condition was good and there were no specific findings, except for the skin lesion. On the visit, laboratory studies, including complete blood cell count with differentials, peripheral blood smear, liver and renal function test, VDRL, urinalysis, stool examination, hepatitis viral test, HIV test, chest X-ray, and electrocardiogram were all within normal limits or negative.
KOH mount did not result in fonsecaeea of any etiological agent. However, tissue biopsy conducted by culturing the tissue in the Sabouraud’s dextrose slant medium showed slow growing, velvet-like, dark brown colonies, with slightly elevated center.
Same result was found with subculture on plate medium Fig. According to microscopic examination with Lactophenol cotton blue staining fosecaea hyphae and conidia, conidiophores were brown, and ovoid conidia were located either at end or at the side of conidiophores Fig. Histopathological examination revealed fonseecaea granulomatous inflammation, with phase disseminated hyperplastic, minute abscess and intradermal lymphocytes, histiocytes, and giant cells Fig. Also, large spherical thick walled cells formed a cluster Fig.
Subsequently, using the Blast program, it was compared to the pedrosoo sequence of the reported strain in Thailand stored in GeneBanki. With clinical, histopathological and mycological results, as well as molecular biological findings, we were able to diagnose the patient as having chromoblastomycosis caused by the strain F.
The patient showed clinical improvement to 3 months oral administration of itraconazole, mg per day. Elliptical, brownish conidia from conidophore were seen in the slide culture of F. Large, pedroosi brown, septate cells, i.
Alignment of ITS sequences of the sample from the patient and F. Chromoblastomycosis is a chronic fungal disease mostly localized in the skin and the subcutaneous tissue. The disease is caused by dematiaceous fungi, with commonality of the melanin pigment containing cell wall. The infection is through open wound on the skin.
Although there were some reported cases of animal infection, most infections occur in human subjects This disease is reported in all continents. However, humid tropical and subtropical regions of America, Asia and Africa had more frequently reported the incidents 12 and the etiologic agent was most often F. Other etiologic agents are Cladosporium Cladophialaphora carrioniiPhialophora verrucosaRhinocladiella aquaspersaF.
The most reported agent responsible for incidents in Korea 5 cases 9 – 13also was F. The disease generally occurs more frequently in males then females and all ages can be affected. The fonsecafa and sex distribution can differ depending on the region. In Japan, however, the incidence of male and female was similar and people over 50 were most affected by the disease 6. In Korea, the ratio of incidents in regards to sex was similar to Japan, in that 4 cases were male and 5 cases were female this case included.
With regard to age, 7 out of 9 cases occurred in the age group over 50, which is also similar to the trend in Japan, rather than South America Table 1 8 – This disease generally manifest itself on the lower extremity rather than the upper extremity, and the skin rash mostly starts off as red papule and gradually takes various forms, such as verrucous nodule or plaque 5.
In Korea, however, the infection occurred more often on the upper extremity rather than the lower extremity. The low extremity was infected more in males, whereas the upper extremity was more infected in females.
Clinical manifestations were mostly erythematous plaque type or nodular plaque type. This is also similar to the case reports from Japan, rather than from South America 17 Therefore, it seems to be a correlation between the geographical region and the incidents.
This regional discrepancy might derive from differences in the level of industrialization and life style. Histopathologically, chronic granulomatous inflammation, with phase disseminated hyperplastic, minute abscess and intradermal inflammatory cells were identified. Also characteristic, when the massive intradermal cell or separation by large spherical thick wall sclerotic or muriform cell can be seen, then it can be diagnosed as Chromoblastomycosis.
The sclerotic or muriform cell can pderosoi observed easily, even in non-stained samples 9 In this case, the same results were observed. Mycological opinion was formed from the following findings. The microscopic examination resulted in identification of 3 types of sporulation.
First, was the Cladosporium type, where conidium is formed, leading to chains. Second, was the Rhinocladiella type, where spore is formed at either the end or the side of the conidophore.
Third, was the Phialophora type, where spore is formed at the end of the fonswcaea type conidophore, named Phialide 2. In this case study, the KOH mount did not result in finding of any etiologic agent. However, the tissue biopsy conducted by culturing the tissue in the Sabouraud’s dextrose medium showed slow growing, velvet-like, dark brown colonies, with slightly elevated center. According to the microscopic examination, the spores were oval in shape and displayed the Cladosporium type sporulation.
Recently, De Hoog et al. Subsequently, they classified them into group A, B and C. InYaguchi et al. The A2 group was the strain from Central and South America. The patient in this case was a Thai worker living in Korea and the base sequence matched the reported F.
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This was in accordance with the regional distribution findings of Yaguchi et al. With clinical, histopathological and mycological results, as well as molecular biological findings, we were able to diagnose the patient as having chromoblastomycosis by the strain F.
The initial treatment consisted of fnsecaea, skin grafting and other treatments, such as localized hyperthermia and cryosurgery or administering itraconazole, 5-fluorocytosine, or amphotericin B 1 – 3.
Effective treatments usually try to prevent the localized recurrence by wide margin excision of small or localized lesion areas. However, as in our case, too extensively distributed lesions and deep infections were not suitable for excision. Thus, in our case, we could not perform surgical excision, because of extensive distribution of the ;edrosoi. The patient showed clinical improvement to 3 months oral administration of itraconazole.
National Center for Biotechnology InformationU. Journal List Ann Dermatol v. Published online Aug 6. Dong Min KimM. Find articles by Dong Min Kim.
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Find articles by Jeonghyun Shin. Find articles by Sung Hyub Han. Author information Article notes Copyright and License information Disclaimer. Moo Kyu Suh, M. This article has been cited by other articles in PMC. Abstract We report herein a case of chromoblastomycosis caused by Fonsecaea F. Open in a separate window. Multiple, scaly erythematous plaques, with ulcers and erosions on the left shin.
Table 1 Clinical features fonsecada the Korean cases of subcutaneous chromoblastomycosis. Infectious caused by dematiaceous fungi.