Brown, Michael

Pasvol, Geoffrey

LSHTM Research Online

Brown, M; Pasvol, G (2005) Images in clinical medicine. Chromoblas-tomycosis. The New England journal of medicine, 352 (20). e19.ISSN 0028-4793 DOI: 10.1056/NEJMicm040848Downloaded from: http://researchonline.lshtm.ac.uk/13652/DOI: 10.1056/NEJMicm040848Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Copyright the publishers n engl j med  352;20 www.nejm.org may  19, 2005 The  new england journal  of  medicine e 19 images in clinical medicine Chromoblastomycosis Michael Brown, M.R.C.P., Ph.D. London School of Hygiene and Tropical MedicineLondon WC1E 7HT, United Kingdom Geoffrey Pasvol, F.R.C.P., D.Phil. Imperial CollegeLondon W2 1PG, United Kingdom 67-year-old man was admitted to the hospital with a 12-year history of swelling of his left leg. He had emigrated to the United Kingdomfrom Jamaica at the age of 31 years. When the patient was 41 years old, a golf-ball–sized nodule was excised from the dorsum of his left foot, and he was told he hada fungal infection. At that time, he did not receive any further treatment. At the age of55 years, the patient noticed that a nodule had developed on his left shin. He did notseek medical attention until the lesion had spread and become so extensive that he wasunable to walk (Panels A and B). A skin biopsy revealed a suppurative and granulomatousinfiltrate with clusters of brown fungal organisms (muriform cells), a finding diagnosticof chromoblastomycosis (inset). A rhinocladiella species was cultured from skin scrap-ings. The patient was treated for 24 months with itraconazole and terbinafine, whichresulted in improved mobility and substantial drying of the lesions, but warty changes,hyperpigmentation, and lymphedema persisted. Copyright © 2005 Massachusetts Medical Society.aA BThe New England Journal of Medicine Downloaded from nejm.org at LONDON SCH HYGIENE & TROPICAL MED on February 19, 2014. For personal use only. No other uses without permission.  Copyright © 2005 Massachusetts Medical Society. All rights reserved. 

Images in clinical medicine. Chromoblastomycosis.

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Images in clinical medicine. Chromoblastomycosis.

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