Carcamo, Paloma M

Schwalb, Alvaro

Seas, Carlos

LSHTM Research Online

Am. J. Trop. Med. Hyg., 103(2), 2020, pp. 547–548doi:10.4269/ajtmh.20-0243Copyright © 2020 by The American Society of Tropical Medicine and HygieneImages in Clinical Tropical MedicineChromoblastomycosis: A Case of a Verrucous Plaque from the TropicsPaloma M. Carcamo,1* Alvaro Schwalb,2 and Carlos Seas1,21School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; 2Instituto de Medicina Tropical Alexander von Humboldt, UniversidadPeruana Cayetano Heredia, Lima, PeruA 65-year-old man from a rural town in Ucayali, in thePeruvian Amazon jungle, presented to the infectious diseaseoutpatient clinic at Hospital Cayetano Heredia, with a 6-yearhistory of illness characterized by a cutaneous lesion in his leftforearm that caused mild pruritus. He had previously seenvarious medical specialists and received treatment with pen-tavalent antimonials for suspected cutaneous leishmaniasisand standard regimen for suspected cutaneous tuberculosis,with no improvement. He worked at a farm where he was in-volved in manual agricultural labor. Physical examinationrevealed a slightly elevated, dry, verrucous plaque with anatrophic center, peripheral desquamation, and numerousblackdots (Figure 1). Directmicroscopyof a skin scrapingwith10% KOH revealed abundant muriform cells (Figure 2), alsoknown as Medlar bodies, which are pathognomonic forchromoblastomycosis.Chromoblastomycosis is caused by the inoculation ofspores from dematiaceous fungi, primarly from FonsecaeaandCladophialophora. It is prevalent in Southern Africa andsome parts of Latin America, especially Brazil.1 Its preva-lence in Peru has not been thoroughly studied, althoughsporadic cases have been reported in the Amazon region,specifically in Cusco and Ucayali.2 Common causes ofverrucous plaques in the tropics include cutaneous tuber-culosis, leishmaniasis, sporotrichosis, and leprosy, but theblack dots in the lesions are a characteristic of chromo-blastomycosis and represent the transdermal elimination ofdebris which provide the best yield for fungal structures.3About 90% of isolated species are identified as Fonsecaeapedrosoi.4 Treatment involves the prolonged use of oralitraconazole and adjuvant physical methods such as sur-gical excision, heat or cold therapy, and even laser abla-tion.1 Our patient is currently receiving treatment with oralitraconazole and will be periodically monitored for clinicalimprovement.Received April 3, 2020. Accepted for publication April 16, 2020.FIGURE 1. An elevated verrucous plaque with central atrophy andperipheral desquamation, with numerous black dots. This figure ap-pears in color at www.ajtmh.org.FIGURE 2. Muriform bodies in microscopic observation of scrapingof the skin lesion with 10% KOH. This figure appears in color atwww.ajtmh.org.* Address correspondence to Paloma M. Carcamo, Instituto deMedicina Tropical Alexander von Humboldt, Universidad PeruanaCayetano Heredia, Ave. Honorio Delgado 430, San Martı́n de Porres,Lima, Peru 15102. E-mail: paloma.carcamo.g@upch.pe547Authors’ addresses: Paloma M. Carcamo, School of Medicine, Uni-versidad Peruana Cayetano Heredia, Lima, Peru, E-mails: paloma.carcamo.g@upch.pe or paloma.carcamo.g@gmail.com. AlvaroSchwalb, Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail:alvaro.schwalb@upch.pe. Carlos Seas, Instituto de Medicina TropicalAlexander von Humboldt, Universidad Peruana Cayetano Heredia,Lima, Peru, E-mail: carlos.seas@upch.pe.This is an open-access article distributed under the terms of theCreative Commons Attribution (CC-BY) License, which permits un-restricted use, distribution, and reproduction in anymedium, providedthe original author and source are credited.REFERENCES1. Brito AC, Bittencourt MJS, 2018. Chromoblastomycosis: an etio-logical, epidemiological, clinical, diagnostic, and treatmentupdate. An Bras Dermatol 93: 495–506.2. Ramı́rez Soto MC, Malaga G, 2017. Subcutaneous mycoses inPeru: a systematic review and meta-analysis for the burden ofdisease. Int J Dermatol 56: 1037–1045.3. Queiroz-Telles F et al., 2017.Chromoblastomycosis.ClinMicrobiolRev 30: 233–276.4. Bonifaz A, Carrasco-Gerard E, Saúl A, 2001. Chromoblastomycosis:clinical and mycologic experience of 51 cases.Mycoses 44: 1–7.548 CARCAMO AND OTHERS

Chromoblastomycosis: A Case of a Verrucous Plaque from the Tropics.

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Chromoblastomycosis: A Case of a Verrucous Plaque from the Tropics.

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