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SHORT COMMUNICATION
Year : 1991  |  Volume : 57  |  Issue : 3  |  Page : 155-156

Disseminated chromoblastomycosis



Correspondence Address:
K Pavithran


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How to cite this article:
Pavithran K. Disseminated chromoblastomycosis. Indian J Dermatol Venereol Leprol 1991;57:155-6

How to cite this URL:
Pavithran K. Disseminated chromoblastomycosis. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Aug 25];57:155-6. Available from: http://www.ijdvl.com/text.asp?1991/57/3/155/3658


A 42-year-old female developed multiple verrucous nodules and plaques on the skin of the face, neck, trunk and limbs and painful swelling of the throat since 8 months. The disease started one year ago, as a painless, verrucous nodule on the right leg. There was no preceding local injury. For the leg nodule she had been on various antibiotics and a course of systemic steroid for 2 months from a local hospital. After this the disease spread rapidly to other parts of the body including the nasal and oral cavity. Examination revealed multiple, well-circumscribed, round, oval and irregular shaped, dry, verrucous plaques of various sizes on the trunk, limbs, neck and face [Figure - 1]. The lesion on the upper lip ex­tended into the vestibule of the nostril. There was a firm, tender, nodule with necrotic surface on the left tonsil. The lower anterior portion of the cartilagenous part of the nasal septum was found destroyed by the granulomatous lesion. The tonsillar and axil­lary lymph nodes on the left side and the inguinal lymph nodes on the right side were enlarged and matter forming fluctuant ab­scesses. All other systems were clinically normal.

Routine laboratory tests on blood, urine and stools were normal except for an elevated ESR (64 mm first hour). Blood VDRL was negative. Mantoux test was negative, and the x-ray of the chest and paranasal sinuses ap­peared normal. The crusts from the verrucous nodules and the aspirated material from the abscesses, in 10% KOH revealed brown pigmented, branching hyphal strands. The histopathological study of the biopsy speci­mens from the verrucous plaques of the skin, those from the axillary and tonsillar lymph glands and nodule of the tonsil showed granulomatous infiltration with numerous brown-pigmented branching hyphal strands [Figure - 2] and `Sclerotic cells'. Culture of the bi­opsy specimens in Sabouraud's agar revealed growth in 3 weeks and the fungus grown was identified to be Cladosporium carrionii. The patient was initially treated with intravenous amphotericin thrice weekly and later with oral ketoconazole 200 mg twice daily for 4 months. There was only partial therapeutic response. She was discharged from the hospital at her request, after which she was lost for follow-up.

Chromoblastomycosis, caused by one of the several species of dematiaceous fungi, is usually confined to one of the lower extremi­ties and affects only the skin and subcutane­ous tissue, though the lymph glands draining the diseased focus may participate in the pathological process. The mucous membrane is usually not involved; but minor invasion of the conjunctive and nasal septum has been reported.[1],[2] The clinical features and histopathological and mycological studies in our patient confirmed that the skin, lymph gland and tonsillary lesions were all due to chromoblastomycosis. Dissemination of chromomycosis is extremely rare, though metastases to the muscular tissue and brain 'have occasionally been reported[3],[4] Develop­ment of lesions at multiple sites in the skin, lymph glands, tonsil and nasal septum sug­gested that in our patient the disease was disseminated via blood stream. The exact mechanism of such a dissemination is not known. Symmers reported cerebral chromomycosis in a patient with polyarteritis nodosa who was on corticosteroid therapy[5] In our patient also the cortisone she had re­ceived, probably led to wide spread dissemi­nation of the disease. The ketoconazole, a popular new drug in the treatment of deep mycoses, was found to be less effective in our case.

 
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1.Azulay RD and Serruya J : Haematogenous dis­semination in chromoblastomycosis : Report of a generalised case, Arch Dermatol, 1967; 95 : 57­60.  Back to cited text no. 1    
2.Jakamitzu N, Grant JA, Threlkeld R et al : Primary chromoblastomycosis of the nasal septum, Am J Clin Pathol, 1972; 58 : 365-370.  Back to cited text no. 2    
3.Carrion AL and Koppisch E : Observations on dermatomycoses in Puerto Rico : Report on a case of chroroblastomycosis, Puerto Rico J Public Health Trop Med, 1933; 9 : 169-193.  Back to cited text no. 3    
4.Duque 0: Meningoencephalitis and brain abscess caused by cladosporium and fonsecaea, Am J Clin Pathol, 1961; 36 : 505-517.  Back to cited text no. 4    
5.Symmers WSC : A case of cerebral chromoblastomycosis occurring in Britain as a complication of polyarteritis treated with cortisone, Brain, 1960; 83 : 35-51.  Back to cited text no. 5    


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This article has been cited by
1 Chromoblastomycosis in India
Rajendran, C., Ramesh, V., Misra, R.S., Kandhari, S., Upreti, H.B., Datta, K.K.
International Journal of Dermatology. 1997; 36(1): 29-33
[Pubmed]



 

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