Lobomycosis: single lesion on the lip

A 66-year-old male patient, a farmer from Coari, state of Amazonas, Brazil, had a lesion on the upper lip with a 10-year evolution.On examination, an erythematous, infiltrated tumor lesion with a firm consistency was observed on the right side of the upper lip (Fig. 1).The general clinical examination and laboratory tests showed no changes.A biopsy of the lesion was performed and histopathology revealed a nodular granulomatous inflammatory infiltrate involving the entire dermis and hypodermis, consisting of epithelioid histiocytes and numerous giant cells, containing rounded fungal structures in a catenulate arrangement compatible with Lacazia loboi (Figs. 2 and3).Surgical excision of the lesion was performed (Fig. 4) and itraconazole, at a dose of 100 mg, every 12 hours, orally, for six months was prescribed, in an attempt to prevent recurrence.The patient is in the eighth month of follow-up, progressing satisfactorily, without recurrence of the lesion.Lobomycosis (Jorge Lobo's disease) was first described in 1931 by the dermatologist Jorge Oliveira Lobo.It is a subcutaneous mycosis, usually characterized by nodular lesions with a keloid appearance; however, there may be lesion polymorphism, as plaques, papules, macules, verrucous lesions, ulcerations and scarring lesions; it evolutes