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Published by Ernel Tosoc

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Published by: Ernel Tosoc on Sep 26, 2011
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01/23/2014

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Case Report Chromoblastomycosis
NJIRM 2011; Vol. 2(1).Jan-March eISSN: 0975-9840 pISSN: 2230 - 9969
 
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Chromoblastomycosis
Dr. Harshada Shah*, Dr. K.Verma**, Dr. P.L.Dhand***, Dr. Rajesh Soni****, Ms. Pragya Shakya ****
*Prof. & Head, Dept. of Microbiology, **Prof. & Head, Dept. of Skin & Venereal Disease, ***Prof. & Head, Dept. of Pathology,***Assistant Professor, ****P.G. Student, Dept. of Microbiology, RDGMC, Ujjain
Abstract:
Chromoblastomycosis is a chronic fungal infection primarily of skin and subcutaneous tissue caused bya variety of dematiaceous fungal species belonging to different genera. We report a case which remainsundiagnosed for 15 years although it presented with the most common manifestation. It was diagnosed andtreated with excellent clinico-microbiological and histo-pathological correlation.
Key words:
Chromoblastomycosis, Cladosporium carionii, Copper penny bodies.
Corresponding Author:
 
Dr. Harshada Shah
, Professor & Head, Dept of Microbiology, R.D.Gardi Medical College,Surasa, Agar Road, Ujjain (MP) 456006, E
 –
 
INTRODUCTION:
Chromoblastomycosis is a chronic,relatively uncommon, localized mycotic infection of the skin and subcutaneous tissue. Normally, itfollows a traumatic implantation of dematiaceousfungi. The lesions range from verrucoid, ulcerated,crustate or cauliflower like growth to raised or flatplaques. Satellite lesions develop following auto-inoculation and by lymphatic spread to adjacentareas. The disease has been described worldwide,but the incidence is greater in subtropical regions.Large numbers of cases have been reported fromMadagascar and Brazil. Farming is the mostcommon occupation associated with this lesion
1
.
InIndia, most of the cases have been reported in beltsfrom North to South sparing the Eastern andWestern regions
2
.
We present a case of Chromoblastomycosis from Central India.
CASE REPORT:
A 50 year old male agriculturist fromUjjain district in Madhya Pradesh visited the SkinOPD of C.R Gardi hospital in Jan, 2008. Hepresented with a 15 years long history and acauliflower like lesion associated with itching anddepigmentation of right lower limb. Historyrevealed that it began with a small papular lesionon the external surface of right foot with itching.He went pole to post to seek medical attention untilthe lesion increased in size over a period of last 5years. He also tried several home remedies. He wasdiagnosed as a case of tuberculosis at other centerand received anti-tubercular treatment withoutgetting any clinical response. The lesion continuedto progress and reached up to his knee (fig.1).Fig 1Initial KOH mount showed a fair number of round,non-septate structures resembling fungal spores.The skin biopsy done at our center revealed apseudoepitheliomatous hyperplasia with microabscesses and granulomatous infiltrate (fig.2).Fig 2
 
Case Report Chromoblastomycosis
NJIRM 2011; Vol. 2(1).Jan-March eISSN: 0975-9840 pISSN: 2230 - 9969
 
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Classical copper penny bodies with brownpigmentation (sclerotic/ Meddler bodies) werepresent amidst the inflammatory infiltrate (fig.3).Fig 3Culture on SDA with chlormphenicol andcycloheximide from skin scrapings revealed fungalcolonies, which were identified as Cladosporiumcarroionii based on colony morphology andmicroscopy (fig.4)
3
.
 Fig - 04Crooked hyphaeFig - 04 spherical / oval conidia in chainsHematological & biochemical parameters werewithin normal limits. X-ray chest was normal. Thepatient was treated with Terbinafine andItraconazole resulting in improved mobility andsubstantial drying of lesions with warty changes infirst 3 months of the treatment. Unfortunately inspite of our efforts the patient could not befollowed up beyond 6 months.
DISCUSSION:
Chromoblastomycosis usually occurson hands, feet and upper legs. In our patient thelesion extended from foot up to the knee joint. Itdeveloped gradually starting as papular lesion to acauliflower like growth. This is a commondevelopment reported in several other studies. Acase of primary involvement of face has beenreported by
4
.
Usually the lesions
 
remain confined toskin and subcutaneous tissue. However,hematogenous and lymphatic dissemination of themycotic infection with fatal outcome has beendocumented in rare cases.The disease occurs commonly between 20-40 yearsof age with male preponderance. In a review of 34patients by
5
,
the patients aged from 12 to 80 yearswith a male to female ratio of 5.8:1. The abovementioned was a male who got infected at the ageof 35 years .Indian patients with subcutaneouspheohyphomycosis are affected at an earlier age
2
.Culture was positive in 72% of cases and scleroticbodies were observed in 84% cases. In our case, thehistopathology revealed sclerotic bodies and theculture was also positive. Although, a relatively ahigher prevalence (15%) Fonsecaea compacta hasbeen observed
6
,
we identified Cladosporiumcarroini. A case of chromoblastomycosis caused byFonsecaea pedrososi presenting as a small plaqueon the left upper arm: has been reported in reviewof cases of dematiaceous fungal infections inJapan
7
.Extracutaneous involvement has been reported in24 % of cases
8
. Surprisingly with 15 years longhistory there was no extra cutaneous involvementin this case.The characteristic histological and culture findingsdescribed for the disease were present in thispatient. The clinical and histological features of 

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