Verrucous and ulcerovagitant facial chromo-blastomycosis with nasal bridge destruction, cleaving upper lip deformity and exuberant eyelid squamous cell carcinoma- rare debilitating sequel of facial chromoblastomycosis in a non-endemic region: A case report
Abstract
AbstractChromoblastomycosis, refers to a chronic granulomatous and suppurative subcutaneous dematiaceous fungal infection, resulting from traumatic skin inoculation by melanized fungi of Herpotrichiellaceae family, including Fonsecaea pedrosoi, Cladophialophora carrionii, accounted as the most commonly prevalent endemic etiological species in tropical and temperate regions. Chromoblastomycosis still is a therapeutic challenge due to varied clinical forms, the recalcitrant nature, frequent disease recurrence and debilitating sequel. We report a case of verrucous and destructive Facial Chromoblastomycosis in an 8yrs old male child, who initially presented with a 3yrs history of progressive appearance of hyperkeratotic and cauliflower like vegetative mycosis over bilateral extensor forearm and legs prevailing for years with constitutional symptoms, later evolved into verrucous, ulcerovegetant gritty plaques involving ear lobule and pinna, bilateral cheeks, with subsequent nasal bridge destruction, cleaving upper lip deformity and recently unfolded a papillomatous exuberant lower eyelid SCC. Histopathological evidence of cutaneous biopsy was consistent with Chromoblastomycosis while protruding eyelid mass revealed an SCC.References
McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol. 1983;8:1–16.
d'Avila SC, Pagliari C, Duarte MI. The cell-mediated immune reaction in the cutaneous lesion of chromoblastomycosis and their correlation with different clinical forms of the disease. Mycopathologia. 2003;156:51–60.
Mazo Fávero Gimenes V, Da Glória de Souza M, Ferreira KS, Marques SG, Gonçalves AG, Vagner de Castro Lima Santos D, et al. Cytokines and lymphocyte proliferation in patients with different clinical forms of chromoblastomycosis. Microbes Infect. 2005;7:708–13.
Carrión AL. Chromoblastomycosis. Ann N Y Acad Sci. 1950;50:1255–82.
Krishna S, Shenoy MM, Pinto M, Saxena V. Two cases of axillary chromoblastomycosis. Indian J Dermatol Venereol Leprol. 2016;82:455–6.
Barton K, Miller D, Pflugfelder SC. Corneal chromoblastomycosis. Cornea. 1997;16: 235–9.
Bui AQ, Espana EM, Margo CE. Chromoblastomycosis of the conjunctiva mimicking melanoma of the ciliary body. Arch Ophthalmol. 2012;130:1615–7.
França K, Villa RT, Bastos VR, Almeida AC, Massucatti K, Fukumaru D. Auricular Chromoblastomycosis: A Case Report and Review of Published Literature. Mycopathologia. 2011;172:69–72.
Naveen KN, Shetty PC, Naik AS, Pai VV, Hanumanthayya K, Udupishastry D. Chromoblastomycosis presenting as a phagedenic ulcer on the face. Int J Dermatol. 2012;51(5):576-8.
Fatemi MJ, Bateni H. Oral chromoblastomycosis: a case report. Iran J Microbiol. 2012;4:40–43.
Takase T, Baba T, Uyeno K. Chromomycosis A case with a widespread rash, lymph node metastasis and multiple subcutaneous nodules. Mycoses. 1988;31:343–52.
Camara-Lemarroy CR, Soto-Garcia AJ, Preciado-Yepez CI, Moreno-Hoyos F, Hernandez-Rodriguez PA, Galarza-Delgado DA. Case of chromoblastomycosis with pulmonary involvement. J Dermatol. 2013;40:746–8.
Sharma NL, Sharma VC, Mahajan V, Shanker V, Sarin S. Chromoblastomycosis with underlying osteolytic lesion. Mycoses. 2007;50:517–519.
de Azevedo CM, Gomes RR, Vicente VA, Santos DW, Marques SG, do Nascimento MM. Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis. J Clin Microbiol. 2015;53:2674–85.
Torres E, Beristain JG, Lievanos Z, Arenas R. Chromoblastomycosis associated with a lethal squamous cell carcinoma. An Bras Dermatol. 2010;85:267-70.
Bayles MA., Hay RJ. Chromomycosis, Baillière's Clinical Tropical Medicine and Comunicable Diseases. Tropical Fungal Infections, 1986 LondonWB Saunders (pg. 45-70)
Bonifaz A, Paredes-SolÃs V, Saúl A. Treating chromoblastomycosis with systemic antifungals. Expert Opin Pharmacother. 2004;5:247–54.
McGinnis MR, Pasarell L. In vitro evaluation of terbinafine and itraconazole against dematiaceous fungi. Med Mycol. 1998;36(4):243-6.
Ungpakorn R, Reangchainam S. Pulse itraconazole 400 mg daily in the treatment of chromoblastomycosis. Clin Exp Dermatol. 2006;31:245–7.
Criado PR, Careta MF, Valente NY, Martins JE, Rivitti EA, Spina R. Extensive long-standing chromomycosis due to Fonsecaea pedrosoi: three cases with relevant improvement under voriconazole therapy. J Dermatolog Treat. 2011;22:167–74.
Negroni R, Tobón A, Bustamante B, Shikanai-Yasuda MA, Patino H, Restrepo A. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo. 2005;47:339–46.
Caligiorne RB, Resende MA, Melillo PH, Peluso CP, Carmo FH, Azevedo V. In vitro susceptibility of chromoblastomycosis and phaeohyphomycosis agents to antifungal drugs. Med Mycol. 1999;37:405–9.
Bolzinger T, Pradinaud R, Sainte-Marie D, Dupont B, Chwetzoff E. Traitement de quatrecas de chromomycose à Fonsecaea pedrosoi par l'association 5-fluorocytosine-itraconazole. Nouv Dermatol. 1991;10:462–6.
Pavlidakey GP, Snow SN, Mohs FE. Chromoblastomycosis treated by Mohs micrographic surgery. J Dermatol Surg Oncol. 1986;12:1073–5.
Sousa Mda G, Reid DM, Schweighoffer E, Tybulewicz V, Ruland J, Langhorne J. Restoration of pattern recognition receptor costimulation to treat chromoblastomycosis, a chronic fungal infection of the skin. Cell Host Microbe. 2011;9:436–43.
Azevedo CMPS, Leda YA, Oliveira TKM, Barbosa A, Branco DAC. PO247 - Efeito da glucana em um caso de cromoblastomicose refratário a antifúngico In: Pôsters apresentados no 60 o Congresso da Sociedade Brasileira de Dermatologia. Departamento de Micologia; 2005 set 10 a 14. An Bras Dermatol. 2005;80:S226–SS32.
