Overview of Chromoblastomycosis, a neglected tropical disease: case report and narrative review

Abstract

Background: Background: Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis present in tropical or subtropical regions, caused by the traumatic inoculation of various species of melanized fungi, the most common being Fonsecaea pedrosoi and Cladophialophora carrionii. It is characterized in early stages by erythematous macules or papules with a verrucous or hyperkeratotic appearance, which progress to nodular, verrucous, tumoral, plaque, or scar-like morphologies.

Objective: to describe a classic presentation and conduct a narrative review of CBM with a prolonged evolution time and multifocal extension.

Case report: 69-year-old man, a farmer by occupation, with a history of hypertension, heart failure with preserved ejection fraction, colonic diverticulosis, and umbilical hernia. He was admitted to the emergency department with a one-day history of dyspnea, chills, asthenia, adynamia, and fever, consistent with exacerbated chronic lung disease and pneumonia. Given a 10-year history of progressive growth of painless and pruritic papular skin lesions that spread with various presentations to other areas of the body, a potassium hydroxide (KOH) test was performed, revealing mycotic structures and the presence of yeasts. Meanwhile, the skin biopsy reported findings of pseudoepitheliomatous hyperplasia and intraepidermal abscesses with Medlar bodies, pathognomonic of CBM.

Conclusion: The case highlights the importance of an accurate diagnosis of an overlooked tropical disease and the establishment of personalized antifungal treatment, as well as the need for long-term monitoring due to the chronic nature of the pathology and its marked resistance to treatment.

Keywords: Chromoblastomycosis; Neglected diseases; Dermatomycoses.