Chromoblastomycosis in Taiwan: A report of 30 cases and a review of the literature

Abstract

Chromoblastomycosis (CBM) is an implantation mycosis characterized by the presence of pigmented muriform cells in tissue. CBM is endemic in Taiwan, but only three formal cases have been reported to date because of underreporting. To describe and update its epidemiologic features, we report a series of 30 cases between 2003 and 2016 at a single medical center. Patients were predominately male (2.75:1). The mean age of onset was 65.9 years, and disease duration ranged from 2 months to 20 years. Diabetes was the most common comorbidity, and extremities were the most frequent sites of involvement. The lesions presented as papuloplaque, verrucous, cicatricial, targetoid, or mixed types. The dermoscopic features were variable, including red dots, white vague areas, black globules, and sand-like patterns. Among 10 Fonsecaea isolates further identified by sequencing the ITS regions of ribosomal DNA, nine were F. monophora and one was F. nubica. All but one patient received either systemic antifungal agents, surgical excision, or both. Surgical excision achieved a higher complete remission rate than the other forms of treatment did.

Chromoblastomycosis: clinical experience and review of literature

“…Chromoblastomycosis predominates in men between 30 and 50 years, rural workers, with a history of trauma in exposed parts of the body . In our series, the average age was higher, like in Taiwan . In India, the mean age at presentation was 43.3 years, with male to female ratio of 4.2 : 1.…”

“…In all series reviewed, F. pedrosoi and C. carrionii were the most common . Chromoblastomycosis is primarily of the tropics and subtropics.…”

“…In most series, there has been a predilection for the lower legs . In Australia, the upper limbs were more affected by chromoblastomycosis …”

“…Chromoblastomycosis manifests as slow‐growing rough plaques, exophytic, desquamative, with black spots on the surface . Slow clinical progression usually limited to the skin and subcutaneous tissue in which initial erythematous papular lesions might gradually evolve to display varying morphologies …”

Dermoscopic features in nodular chromoblastomycosis

“…Previously reported dermoscopic findings in chromoblastomycosis are of typical plaque and verrucous lesions that focused mainly on surface changes describing crusting and scaling with brown dots, red‐white areas, and yellowish areas . Abundance of brown and black dots on dermoscopy corresponding to the fungal sclerotic bodies has been put forward as the most useful sign in making a diagnosis of chromoblastomycosis .…”