Ann Dermatol.  2010 Aug;22(3):362-366. 10.5021/ad.2010.22.3.362.

Chromoblastomycosis Caused by Phialophora richardsiae

• Son YM
• Kang HK
• Na SY
• Lee HY
• Baek JO
• Lee JR
• Roh JY
• Seo YH

• KMID: 2265378
• DOI: http://doi.org/10.5021/ad.2010.22.3.362

Abstract

Chromoblastomycosis is a chronic fungal disease of the skin and subcutaneous tissues caused by a group of dematiaceous (black) fungi. The most common etiologic agents are Fonsecaea pedrosoi and Cladophialophora carrionii, both of which can be isolated from plant debris. The infection usually follows traumatic inoculation by a penetrating thorn or splinter wound. Several months after the injury, painless papules or nodules appear on the affected area; these papules then progress to scaly and verrucose plaques. We report a case of chromoblastomycosis caused by Phialophora richardsiae, which has been rarely associated with chromoblastomycosis. The case involved a 43-year-old male, who for the past 2 months had noted an erythematous, pustulous plaque that was somewhat dark brown in color on his right shin; the plaque also had intermittent purulent discharge and crust formation. On histopathological examination, chronic granulomatous inflammation and sclerotic cells were seen. The tissue fungus culture grew out the typical black fungi of P. richardsiae, which was confirmed by polymerase chain reaction. The patient has been treated with a combination of terbinafine and itraconazole for 3 months with a good clinical response.

Keyword

Chromoblastomycosis; Phialophora richardsiae

MeSH Terms

Adult
Chromoblastomycosis
Fungi
Humans
Inflammation
Itraconazole
Male
Naphthalenes
Phialophora
Plants
Polymerase Chain Reaction
Skin
Subcutaneous Tissue
Itraconazole
Naphthalenes

Figure

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  Fig. 1 (A) Hyperkeratotic, erythematous black pustular plaque with crust formation on the right shin. (B) The skin lesion gradually improved after 3 months of combination treatment with itraconazole and terbinafine.

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  Fig. 2 (A) Skin biopsy specimen showing hyperkeratosis, pseudoepitheliomatous hyperplasia, and a mixed dermal inflammatory cell infiltrate consisting of lymphocytes, and histiocytes (H&E, ×40). Inset: Periodic acid-Schiff stain reveals a fungal colony in a micro-abscess (×100). (B) Mixed inflammatory cell infiltrate with large, dark-brown, sclerotic bodies (arrow) in the dermis (H&E, ×400). Inset: Sclerotic bodies are found within giant cells (H&E, ×400).

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  Fig. 3 Slide culture and lactophenol-cotton blue stain showed a cluster of conidia accumulating at the apex of the phialides with flared collarettes, giving the appearance of a vase of flowers. Inset: Culture on Sabouraud's dextrose agar at room temperature showed growth of heaped and fuzzy dark brown colored colonies.

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