A case of Chromoblastomycosis

A 55-year-old man presented with vegetating lesions on the right foot that had been slowly enlarging during the past several years ;The photo:

  On physical examination, several nodular and verrucous lesions were seen in the distal region of the foot. The patient lived in a rural area and had walked barefoot for most of his life. Analysis of a skin-biopsy specimen revealed clusters of small, round, thick-walled, brown sclerotic bodies in the stratum corneum (muriform cells), which are diagnostic for chromoblastomycosis.
Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas. The fungi are usually introduced to the skin through cutaneous injury from thorns, splinters, or other plant debris. The patient was treated with multiple surgical excisions and itraconazole for 24 months with a complete resolution of symptoms.