Chromoblastomycosis Treatment With Combination Therapy of Itraconazole (Pulse Dose) and Cryotherapy
Keywords:Chromoblastomycosis, Cryosurgery, Fonsecaea Pedrosoi, Itraconazole
Chromoblastomycosis is a chronic mycosis infection of the skin and subcutaneous tissue. The lesson begins with a history of trauma characterized by slowly gradual growing nodule lesions, especially in the lower extremities. Management of chromoblastomycosis may be physical and non-physical and combination to achieve the best result. A 70-year-old male farmer came with a rough lump on his left leg in the past six years ago. Lesions were multiple-verrucous, varying sizes nodules on the left limb. Skin scraps examination showed copper penny appearance or Medlar bodies. Histopathological examination showed granulomatous inflammation and Medlar bodies. In fungi culture, we obtained Fonsecaea pedrosoi. Patients were treated with a combination of Itraconazole 400 mg/day for a week for three months (pulse dose) and serial cryosurgery once per week. The combination therapy gave clinical improvement and good results. The diagnosis of chromoblastomycosis is based on history, physical examination, histopathology, and culture. Predisposing factors are working in the fields in this case and being exposed to trauma such as soil and plants. Giving combination therapy with itraconazole and cryosurgery makes good results for this patient.
Hay RJ. Deep Fungal Infection. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editor. Fitzpatrick’s dermatology in general medicine, 8th Ed. New York: McGraw Hill; 2008:1831-5.
Sutton DA, Rinaldi MG, Sanche SE. Dematiaceous fungi, In Anaissie EJ, McGinnis MR, Pfaller MA, editor. Clinical Mycology. 1st Ed. New York: Churchill Livingstone; 2009. pp. 329-54.
Queiroz-telles F., Hoog S.D., Santos W.C.L, Salgado C.G, Vicente V. A., Bonifaz A., Roilides E., Xi L., Pedrozo C.E., Azevedo S,, Silva M.B., Pana Z.D., Colombo A.L, and Walshl T.J. Chromoblastomycosis: a Clinical Microbiology review. American Society for Microbiology; 2017.
Sansan MV, Tejo BA, Mulianto N, Dharmawan NA, Mawardi P, Julianto I. Tinjauan retrospektif kasus infeksi kulit di Poliklinik Kulit dan Kelamin Rumah Sakit Dr.Moewardi (RSDM) Surakarta. Jurnal Medika Moewardi. 2013; 2(1): 9-17.
Anaissie EJ, McGinnis MR, Pfaller MA, Editor. Clinical mycology. 2nd Ed. Philadephia: Elsevier Incorporation; 2009. p.344-6.
Kim M, Lee S, Sung H, Won C, Chang S, Lee M, et al. Clinical analysis of deep cutaneous mycoses: a 12-year experience at a single institution. Mycoses. 2012; 55: 501-6.
Samaila M, Abdullahi K. Cutaneous Manifestation of Deep Mycosis: An Experience in a Tropical Pathology Laboratory. Indian J Dermatol. 2011; 56(3): 282-6.
Kazemi A. An Overview on the Global Frequency of Superficial/Cutaneous Mycoses and Deep Mycoses. Jundishapour J Microbiol. 2013; 6(3): 202-4.
Abhisiek D, Gharami RC, Datta PK. Verrucous plaque on the face: what is your diagnosis? Dermatology Online Journal, 2010: 16(1).
Pawel M. Krzdak, Malgorzata Pindycka-Plaszcnska, Michal Piaszczynski. Chromoblastomycosis. Journal Postepi Dermatologi Alergologi Poland. 2014; 5: 310-321.
Queiroz-tells, Flavio, Phillippe Esterre, et al. Chromoblastomycosis: an Overview of Clinical Manifestation, Diagnosis, and Treatment. Medical Mycology; 2009: 47: 3-15.
Ameen M. Chromoblastomycosis: clinical presentation and management. Clin and Exp Dermatol. 2009; 34: 849–854.
Trancoso A, Bava J. Chromoblastomycosis. New England Journal Medicine, 2009: 361:22.
Momin YA, Raghuvanshi SR, Lanjewar DM. Cutaneous chromoblastomycosis. Bombay Hospital Journal. 2008; 50:299-301.
Baddley JW and Dismukes WE. Chromoblastomycosis. In: Kauffman CA, Pappas PG, Sobel JD, Dismukes WE, editors. Essentials of Clinical Mycology. 2nd ed. New York: Springer Science Business Media; 2011: 427-31.
Bobba S. Case Study: chromoblastomycosis. J Trop Dis. 2014; 2 (4): 1-2.
Hay RJ, Ashbee HR. Subcutaneous Mycoses. In: Burns T, Breatnach SM, Cox N, Griffiths C, editor. Rook’s Textbook of Dermatology, 8th Ed. Massachusetts: Blackwell publishing; 2010: 36-69.
Djuanda A. Tuberkulosis kutis. In: Djuanda A, Hamzah M, Aisah S, editor. Ilmu Penyakit Kulit dan Kelamin. Fifth Edition. Jakarta: Balai Penerbit FKUI, 2008; pp. 64-72.
Francisco GB, Eduardo G. Cutaneous Tuberculosis. Clinics in Dermatology. 2007; 25: 173–180.
Schwartz RA, Barran EZ. Chromoblastomycosis. last update: February 11, 2008; Access from www.emedicine.com.
Kayasatha BMM, Shrestha R, Shrestha Pan, Karki A. Chromoblastomycosis mimicking Squamous Cell Carcinoma: a case report. Nepal Journal of Dermatology, Venereology & Leprology; 2009; 8(1): 22-26.
Roy AD, Das D, Deka M. Chromoblastomycosis – A clinical mimic of squamous carcinoma. Australas Med J; 2013; 6(9): 458–460.
Queiroz-telles F. Chromoblastosis: a Neglated Tropical Disease. Rev Institution Medical Tropic Sao Paulo; 2015.
Ahsan M.K., Al Attas K.M, Burak M.A., Al-Sheikh A.M, and Bajawi S.M. Hidden under a cauliflower-like growth: A case of cutaneous chromoblastomycosis and response to combination therapy. Journal of Dermatology & Dermatologic Surgery; 2017.
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