Cutaneous chromoblastomycosis mimicking tuberculosis verrucosa cutis: look for copper pennies!

Abstract

Chromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin.Here in we report a case of chronic cutaneous Chromoblastomycosis in a middle aged woman from north eastern part of India, who was initially misdiagnosed as tuberculosis verrucosa cutis. In histopathology characteristic brown colored spores of the fungus (also known as copper pennies) were seen within dermal abscess. The organism isolated from culture of the biopsy material was Fonsecaea pedrosoi thus confirming our diagnosis of cutaneous chromoblastomycosis. The patient responded well to oral Itraconazole.The dermatologists and pathologists should be aware of this condition especially when dealing with verrucous lesion of the skin. The pathologists should search for fungal spores in cutaneous lesion with pseudoepitheliomatous hyperplasia and dermal abscess.

Chromoblastomycosis in a Diabetic Patient Without a History of Trauma

“…Other histopathological features of cutaneous CBM include epithelial hyperplasia, dermal abscess formation, and chronic granulomatous inflammation with multinucleated giant cells. 10 H&E staining of our patient's biopsy showed epidermal hyperplasia with a granulomatous dermal infiltrate and granulomatous inflammation with numerous neutrophils and scattered Medlar (sclerotic) bodies (Figs. 2-4).…”

“…8,11,[13][14][15] Cure rates with ITZ or TBF vary from 15% to 80%, according to the published data. 10,14 The results of such studies depend primarily on the etiologic agent and the severity of the infection. 11 Queiroz-Telles et al 16 evaluated the efficacy and tolerability of ITZ (200-400 mg/d) in 19 Brazilian patients with CBM because of F. pedrosoi demonstrating its effectiveness.…”

Chromomycosis: Case Reports of Exuberant Forms Including Carcinomatous Degeneration

“…Histopathology is important for diagnosis and confirmation of chromomycosis, especially in nodular and ulcerative cases. Misdiagnosis with squamous cell carcinoma and cutaneous tuberculosis is not rare (Bonifaz et al, 2001;Jakopp et al, 2013;Bandyopadhyay et al, 2015). Furthermore, it is essential to carefully follow chronic lesions due to the risk of squamous cell carcinoma development (Queiroz-Telles, 2015;Lupi et al, 2005;Torres-Guerrero et al, 2012).…”

Chromoblastomycosis as a mimicker of neoplastic lesion: A case report

“…Hence, they may be confused with TB verrucosa cutis, leprosy, squamous cell carcinoma, sporotrichosis, and palmar-plantar psoriasis. [13,[14][15][16] This case was clinically suspected to be a neoplastic one. The diagnosis of chromoblastomycosis gave tremendous relief to the patient as well as the treating physician.…”