Chromomycosis. A Case with a Widespread Rash, Lymph Node Metastasis and Multiple Subcutaneous Nodules

Abstract

Summary: The patient is a male aged 62 living in Ibaraki Prefecture. Eight years ago, a rash first appeard on the left side of the lower back during summer. Two years later, the rash had spread to almost the entire body. In 1983, he was diagnosed by the dermatological department of the Mito Kyodo Hospital as having chromomycosis due to Fonsecaea pedrosoi. He received treatment using flucytosine without any significant improvement. Superficial lymph node swellings and multiple subcutaneous nodules appeared in December of 1985. He entered our institute in May of 1987. In addition to a rash, subcutaneous nodules, and lymph node swellings, at that time abnormal shadows were observed in both lungs and the liver. F. pedrosoi was isolated from the rash, subcutaneous nodules and lymph node swellings. F. pedrosoi was also isolated from a fluid obtained by brushing the left lung through a bronchus. The lesion of the right lung was excised. He was pathologically diagnosed as having squamous cell carcinoma. Findings suggesting infection by black fungi were not observed in this lesion and no fungi were isolated from this lesion. Zusammenfassung: Bei einem 62‐jährigen Mann aus der Ibaraki‐ Präfektur zeigte sich vor 8 Jahren im Sommer zum ersten Mal ein Rash auf der linken Seite des unteren Rükkens. Zwei Jahre später hatte sich der Rash fast ganz über den Körper ausgebreitet. 1983 wurde bei ihm in der dermatologischen Abteilung des Mito Kyodo Hospitals eine durch Fonsecaea pedrosoi bedingte Chromomykose diagnostiziert. Er wurde mit Flucytosin behandelt, ohne daß sich sein Zustand signifikant besserte. Im Dezember 1985 machten sich oberflächliche Lymphknotenschwellungen und multiple, subkutane Knoten bemerk‐bar. Er wurde im Mai 1987 in unser Institut aufgenommen. Zusätzlich zum Rash, zu den subkutanen Knoten und den Lymphknoten‐schwellungen wurden zu dieser Zeit abnormale Verschattungen auf beiden Seiten der Lunge und in der Leber gesehen. F. pedrosi wurde vom Rash, aus den subkutanen Knoten und den geschwollenen Lymphknoten isoliert. Außerdem wurde F. pedrosoi aus dem Bürstenabstrich eines Bronchus auf der linken Lungenseite gezüchtet. Die Läsion in der Lunge rechts wurde exzidiert. Die pathologische Untersuchung ergab ein Plattenepithelkarzinom. In dieser Läsion konnten Chromomykose‐Erreger weder mikroskopisch noch kulturell nachgewiesen werden.

Chromoblastomycosis

“…Lymphatic spread to somewhat remote sites has been described in a few cases (245,246). After months or even years, if not surgically removed, the initial CBM lesion evolves, assuming polymorphic clinical aspects.…”

Case of chromoblastomycosis with pulmonary involvement

“…Moreover, Medlar bodies have been found in brain tissue, and it has been demonstrated that they can germinate and form hyphae even in cutaneous lesions . Medlar bodies have been also found in lymph nodes and in the liver . We did not observe hyphae in the tissue obtained from the bronchial mass, but affection could be segmental, or this could be due to an extremely indolent (15 years) course of the disease .…”

“…The only possible risk factor in our patient was a clinical state of malnutrition. CBM involvement has been reported in cerebrum, cornea, liver and lymph nodes . Here, we report a case of CBM with pulmonary involvement.…”

“…CBM involvement has been reported in cerebrum, 7 cornea, 8 liver 9 and lymph nodes. 10 Here, we report a case of CBM with pulmonary involvement. The lung lesions were positive for Medlar bodies on analysis.…”

Chromoblastomycosis: still a therapeutic challenge

“…Although lymphatic and hematogenous spread of the disease, as well as autoinoculation, are possible, the most common mechanism of dissemination of the disease is expansion to neighboring areas [69,70].…”