Chromoblastomycosis with suspected dissemination to spine: A case report

Introduction: Chromoblastomycosis is a chronic subcutaneous fungal infection caused by the inoculation of pigmented (dematiaceous) fungi. Disseminated chromoblastomycosis is a very rare form that spreads to the bones, lymph nodes, or respiratory tract and has a poor prognosis. Herein, we report a case of chromoblastomycosis with suspected dissemination to the spine. Case presentation: A 67-year-old man presented with a chief complaint of hard, scaly, pruritic lumps on the lumbar region, gluteal region, and left lower limb that had become thicker and emitted a foul odor for 4 weeks. Dermoscopic examination from a plaque on the left lower limb showed scattered reddish-black dots. Histopathologic examination from skin biopsy and 10% potassium hydroxide of skin scraping revealed muriform cells (Medlar bodies). The morphology of fungal plate culture colonies was in accordance with Phialophora verrucosa Medlar . Molecular diagnostic tests for Mycobacterium tuberculosis in sputum and cutaneous tissue were negative. Magnetic resonance imaging showed tuberculous spondylitis, which was difficult to distinguish from spinal dissemination of fungal infection. Discussion: The initial lesion in this case was reported in form of small verrucous plaque on the upper left anterior femoral region and spread slowly for 48 years to affect the entire left lower limb and nearby areas, with suspected dissemination to spine. The patient complained from lower back pain and walking difficulty and was diagnosed with paraparesis by neurology department, and refered to dermatology clinic for the extensive skin lesion. The clinical manifestation suggested a differential diagnosis of chromoblastomycosis, cutaneous tuberculosis, and skin malignancy. The diagnosis of chromoblastomycosis was confirmed by histopathological examinations, and the patient was given oral antifungal, but extensive lesions yielded inadequate treatment. Conclusion: Disseminated chromoblastomycosis carries high morbidity and mortality rates. The diagnosis and treatments are complicated, especially for spine involvement, requiring multidisciplinary combination for a long period.