|Year : 2000 | Volume
| Issue : 2 | Page : 99-100
Chromomycosis: Subcutaneous cystic type
PR Bhise, PR Sony
P R Bhise
A 38-year -old male farmer presented with a solitary, asymptomatic, cystic lesion on the palm since last four years. He underwent excision of this cyst two times during this period but the lesion recurred near the same site. The histopathology and the microbiological examination led to the diagnosis of the rare subcutaneous cystic type of chromomycosis.
Keywords: Chromomycosis, Cyst, Phialophora
|How to cite this article:|
Bhise P R, Sony P R. Chromomycosis: Subcutaneous cystic type. Indian J Dermatol Venereol Leprol 2000;66:99-100
| Introduction|| |
Chromomycosis is an uncommon cutaneous mycosis in which the primary lesion is thought to develop as a result of traumatic implantation of the fungus into the skin. In addition to the usual cutaneous verrucous type of chromomycosis, there are two rare forms, subcutaneous and cerebral.  The cutaneous verrucous type is usually caused by one of the five closely related dematiaceous (pigmented) fungi and the lesions are most commonly located on the lower extremities and consist of verrucous nodules and plaques. The subcutaneous cystic type is usually caused by Phialophora gougertti and the lesion consists of a solitary asymptomatic subcutaneous cyst located most commonly on the hands and ankles.  This article deals with this rare form of chromomycosis which was confirmed by the characteristic histopathology, and culture.
| Case Report|| |
A 38-year-old man presented with an asymptomatic nodular swelling over the left palm since four months The lesion started as a small, skin- coloured, papule and gradually increased to attain the present size. Patient gave history of having similar lesion at the same site twice in last four years. On first occasion, four years back, a surgeon without any further investigations of the tissues excised it and the patient was alright for next two years. Then the lesion recurred just near to the past one and again this time the lesion was excised and the histopathology pointed towards the possibility of chromomycosis. Patient was given oral ketoconazole for three weeks and the patinet was alright till this episode. There was history of repeated trauma to the hands. There was no personal or family history of tuberculosis or history suggestive of syphilis. On examination a solitary nodule about 2cm in diameter, skin- coloured, was present on the left plam just below the ring finger. The nodule was cystic in consistency, non-tender, mobile, and it was not attached to the deeper structuers. There was no local or generalised lymphadenopathy. No n other site was involved and the systemic examination was normal. His total and differential leucocyte count, ESR, and X-ray chest were normal. RPR test was negative. The KOH smear of scales revealed the sclerotic bodies and the Sabouraud's culture after three weeks showed blackish brown folded colony with black posterior which was powdery and, velvety. The LCB mount showed swollen and distorted hyphae with asexual spores. Slide culture revealed conidiophores which were flask shaped, characterisitc of phiaophora. The histopathology revealed cluster of pigmented fungal spores and sclerotic fungal bodies surrounded by marked chronic granulomatous inflammatory reaction with presence of foregin body type of giant cells.
With these findings, a diagnosis of subcutaneous cystic type of chromomycosis was made and the patient was started on oral itraconazole 200 mg daily. With three months of treatment patient showed minimum response. Then cryotherapy with liquid nitrogen spray was done. Two 10 seconds cycles were done and the patient showed good relief after four weeks when the crust fell down. The patient is still on follow-up.
| Discussion|| |
Chromomycosis could be more prevalent than few sporadic cases reported in India over the years particularly in population living near the forests,in agricultural workers and in areas with heavy rain fall. ,,, Our patient belonged to Melghat region having dense forests. Subcutaneous cystic type is a rare type of chromomycosis caused by phialophora. This could probably be the first report of cystic chromomycosis from India.
Treatment of chromomycosis can be frustrating most of the times. Itraconazole and ketoconazole were not much effective in this case. Surgical excision is not recommended.  Cryosurgery with liquid nitrogen also shows variable results and has been tried by other workers in India ,
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[Figure - 1], [Figure - 2]