A case report on role of surgery in a case of difficult chromoblastomycosis

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. It is most commonly reported in tropical and subtropical rural areas, often affecting farmers due to their increased risk of traumatic injury. Untreated or inadequately treated chromoblastomycosis can be a painful and protracted disease. We present the case of a healthy, middle-aged housewife with no history of trauma who presented with a large lesion on her knee. Initial direct microscopy of a potassium hydroxide (KOH) mount was negative. However, histopathological examination revealed characteristic sclerotic bodies. Fungal culture on Sabouraud dextrose agar yielded an olivaceous-brown growth of a Phialophora species. DNA sequencing was performed for species identification. The patient was treated with systemic antifungal medication and surgical excision of persistent nodules. This case highlights the importance of surgical excision in managing refractory chromoblastomycosis.