Nodular lesions of the buttock for 20 years: the challenge of chromoblastomycosis in non-endemic settings.

William Osborne, Gerald Langman, Evmorfia Ladoyanni, Amy Chue

BMJ case reports 2024 Mar 15

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Chromoblastomycosis is an implantation mycosis of the skin caused by certain species of melanised fungi. A man in his 50s, born in Kerala but living in England for 14 years, presented with a nodular lesion on his left buttock, which had been present for 20 years. Biopsy revealed muriform cells and fungal culture isolated Fonsecaea spp, consistent with a diagnosis of chromoblastomycosis. Treatment with oral terbinafine was initiated and changed to itraconazole based on results of antifungal susceptibility. Drug intolerance and low drug levels of itraconazole necessitated change to voriconazole and topical terbinafine. Despite long-term combined therapy, the lesions worsened, and the patient opted for surgical excision abroad. Recurrence was evident at surgical sites and combined therapy continues. Chromoblastomycosis is an insidious and burdensome neglected tropical disease. Within non-endemic countries, diagnosis remains challenging. A travel history and appropriate fungal investigations are vital. © BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

William Osborne, Gerald Langman, Evmorfia Ladoyanni, Amy Chue. Nodular lesions of the buttock for 20 years: the challenge of chromoblastomycosis in non-endemic settings. BMJ case reports. 2024 Mar 15;17(3)