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Primary Chromoblastomycosis: Operate!
Vidya Shankaran, M.D.
Gary Pennington, M.D.
Summa Health System, Akron City Hospital
2014-03-14
Presenter: Vidya Shankaran
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Douglas Wagner, M.D.
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Chromoblastomycosis was first observed in Brazil in 1911 and subsequently described by Pedroso and Gomes in 1920. It is a chronic, subcutaneous mycosis caused by filamentous, pheoid or dematiaceous fungi. Causative saprophytes have been found in Central/South America, southern China, sauna baths in Finland, and in the southwestern United States. Primary chromoblastomycosis is rare in the United States and is most often noted in immunocompromised patients. Though its course is usually indolent, long-standing lesions may become locally invasive, infected, or disseminated. In this case, an elderly, immunocompromised gentleman exhibits an aggressive primary chromoblastomycosis.
Case Report
An 84 year-old male presented with a 3-month history of an ulcerated lesion of the left hand (Figure 1). He had no history of trauma. Given its rapid growth/evolution, the patient was taken for operative excision of these lesions. Pathology reports from the lesion revealed chromoblastomycosis caused by Exophilia jeanselmei. The patient's history is notable for longstanding vasculitis for which he had been taking chronic oral steroids. Despite excisions to negative margins, the patient expired one month following surgery.
Discussion
Chromoblastomycosis remains rare in the United States, and most sufferers are either agricultural workers (80%) or immunocompromised. Oral therapy (itraconazole or terbinafine) combined with cryosurgery is successful early lesions. Similarly, surgical excision preceded by oral therapy has proven successful in many patients.
Immunocompromised patients tend to have aggressive clinical courses and are often not candidates for potent antifungals. Therefore, early and proactive surgical debridement often results in the best outcomes for these patients.
