This is the report of a case of chromomycosis developing on the skin, left lung, brain, lymph nodes, liver, ileocecal region and kidney of a 15-year-old Japanese boy. Phialophora gougerotii from the skin lesions on the back and left upper arm and Phialophora dermatitidis from the left lung, brain, lymph nodes, kidney, as well as the skin lesions on the face, neck and chest were isolated.In Japan, more than 100 cases of chromomycosis have been reported since its first description by Kano (1) in 1934. As systemic chromomycosis, a total of 21 cases, including those reported by the authors, are on record so far. Our case was a rare one, complicated by extensive pathologic changes in the internal organs as well as the skin, and two kinds of dematiaceous fungi were isolated from the lesions, as reported as follows.
REPORT OF CASEA 15-year-old male, with a five-year history of complaints of skin eruptions on his back, was hospitalized in January 1972. The lesion was 20 X 14 cm in size and spread from the back to the loin in a triangular form, brownish and somewhat raised with scales. The right border of the lesion was covered with crusts and was partially ulcerated (Fig. 1). Afterward, lesions appeared on the left buttock. Fungus elements were positive in KOH preparation. In the chest planigram (Fig. 2), tomography, and bronchography three cavity-like shadows were observed in the left pulmonary field, and ca. 5 cc yellow turbid pus was removed from the largest round shadow by exploratory puncture. Fungus elements were also positive in the pus.Biopsy: Biopsy specimens from the ulcerated area demonstrated distinctive hyperkeratosis and . parakeratosis, and rete ridges reached the corium irregularly, showing pseudoepitheliomatous hyperplasia. In the upper and middle layer of the dermis, there were zonular granulomatous structures (Fig. 3).In PAS stain, long hyphae were abundant in the extended rete ridges, presenting almost no spore (Fig. 4). But, in giant cells, hyphae and numerous spores were present, while typical sclerotic cells were not observed.Skin reaction: The intradermal reaction, with culture filtrate of Hormodendrum pedrosoi as an antigen, proved positive.Laboratory findings: There were no distinctive changes in blood, urine, liver functioning and electrolytes. In the precipitation test, using a water soluble substance composed mainly of polysaccharide from Hormodendrum pedrosoi and dematiaceous fungi isolated from the skin and lung of the patient as antigens, the serum of the patient showed positive reactions, while that of the controls were negative.Clinical course: In February, eruptions the size of a finger tip with crusts and erosions developed on the left upper arm. In September, symptoms suggestive of increased intracranial pressure appeared. The cerebral angiogram revealed spaceoccupying lesions in the left cerebral hemisphere and the cerebral scintigram showed a hot spot in the left parietal lobe (Fig. 5). On September 21, craniotomy was performed and a brown and partially greenish brown granuloma of ...
