Title : Chromoblastomycosis infection caused by fonsacea in an immunocompetent filipino male: A case report of a neglected tropical disease
Chromoblastomycosis is a chronic subcutaneous fungal infection characterized by the presence of muriform cells commonly diagnosed among countries in tropical and subtropical regions like Africa, Latin America, India, China, Japan, Malaysia and Australia. In the Philippines, updated data regarding its occurrence is unknown. Due to low fungal disease surveillance, its burden has never been estimated. We then aim to present a case of chromoblastomycosis caused by Fonsacea in an immunocompetent Filipino male.
Case Summary: A 31-year-old immunocompetent Filipino male presented with multiple nodules on the dorsum of the left foot. In a duration of 2 years, what started as a small punctured wound, later progressed to a 5 x 3 x 2.5 cm reddish brown, moist, multi-nodule. Upon consult, excision and biopsy were performed, with suggestive finding of a chronic granulomatous inflammation. He was empirically treated for tuberculosis for 6 months, resulting to the recurrence of the mass. A repeat incisional biopsy on the lesion was performed which revealed granulomas with surrounding sulfur granules, and with fungal elements highlighted by Periodic acid–Schiff and reticulin stains. Initial histopathological findings were suggestive of a eumycetoma infection however microscopy and culture revealed an infection caused by Fonsacae pedrosoi. The patient was then started on itraconazole 200 mg/day for 9 months, leading to the lesion’s complete resolution.
Conclusion: Fungal infections should always be included as a differential diagnosis of a suspicious nodule. The case emphasizes the significance of a comprehensive work-up to confirm the diagnosis of a chronic subcutaneous fungal infection thereby preventing severe tissue damage, deformity, and incapacity. Furthermore, this case emphasizes the need and significance of documentation in order to establish the local epidemiological profile of this often neglected tropical disease, and also to create appropriate guidelines of care.
Keywords: Fonsacea, fungal infection, itraconazole
LEARNING FROM THE PRESENTATION
- The presentation would help health workers in diagnosing and managing neglected disease like Chromobastomycosis.
- The presentation would emphasized the importance of documentation in the establishment of local epidemiological profile
- Present the practice and standard management of Chromoblastomycosis in a third world country.