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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 221-222
Chromoblastomycosis of chin masquerading as facial wart


Department of Pathology, S.C.B. Medical College, Cuttack, Orissa, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Mishra A, Tripathi K, Biswal P, Rath J. Chromoblastomycosis of chin masquerading as facial wart. Indian J Pathol Microbiol 2011;54:221-2

How to cite this URL:
Mishra A, Tripathi K, Biswal P, Rath J. Chromoblastomycosis of chin masquerading as facial wart. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Nov 22];54:221-2. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/221/77422


Chromoblastomycosis (CM) is a chronic granulomatous mycotic infection caused by pigmented fungi, the most common causative agent being Fonsecaea pedrosoi. [1] Majority of the cases are seen in the extremities. There are very few reported cases of involvement of the face by the organism. [2] The lesion is commonly seen in agricultural workers, where the infection is acquired by traumatic implantation or dissemination. [1],[2] This lesion may be warty, plaque-like or tumorous. Diagnosis can be made by light microscopy of the fungus, supported by culture methods. Itraconazole is the drug of choice for these patients.

A 29-year-old male presented with an ulcerated warty growth, measuring about 3 cm in diameter, over the chin, of 1 year duration [Figure 1]. There was no history of any injury prior to the onset of the lesion. The patient had no regional lymphadenopathy or any systemic complaints. He was not a diagnosed case of CM of lower extremities. The lesion was excised and sent for histopathological (HP) examination.
Figure 1: An ulcerated warty growth measuring about 3 cm in diameter over the chin

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The gross received was an irregular skin-covered mass measuring about 3 cm in diameter. Routine hematoxylin and eosin (H and E) staining revealed pseudo-epitheliomatous hyperplasia of the epidermis, with sub-epidermal granulomatous inflammation. Many golden brown thick-walled round fungal bodies were seen in singles and short branching chains [Figure 2] and [Figure 3]. The culture of the tissue revealed the organism to be F. pedrosoi. A diagnosis of CM was made and the patient was advised oral itraconazole theraphy, with clinical cure in 6 months.
Figure 2: Hyperplastic epithelium and underlying fungal bodies (H and E, ×100)

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Figure 3: Golden brown rounded fungal bodies (H and E, ×400)

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CM is a chronic fungal infection of the skin and subcutaneous tissue, commonly involving the extremities. [1],[2] It typically occurs in farmers, in the lower extremities, following traumatic implantation. The lesion can involve other sites by autoinoculation, direct spread or hematogenous spread. Cases of lymphatic dissemination have also been reported. [1],[2]

The face is a very rare site of involvement. Other rare sites include nasal ala, ear tonsil, tracheolaryngeal region, penile shaft, vulva, ileo-cecal region and pleural cavity. [2] Carrion [3] described five types of lesions in a case of CM - nodules, tumors, plaques, warty lesions and scarring lesions. In our case, the lesion was warty.

The diagnosis of CM is based on KOH examination, identification of organism in histological sections and culture of the organism which reveals slowly growing green to black colonies. The microscopic appearance of the conidia formation identifies the species. [4] Itraconazole is the treatment of choice. [5] In the mild to moderate form of the disease, complete cure occurs within 7 months of therapy. We have reported this case because of its rare location and its clinical confusion with a facial wart.

 
   References Top

1.Muhammed K, Nandakumar G, Asokan KK, Vimi P. Lymphangitic chromoblastomycosis. Indian J Dermatol Venereol Leprol 2006;72:443-5.  Back to cited text no. 1
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2.De A, Gharami RC, Datta PK. Verrucous plaque on the face: What is your diagnosis? Dermatol Online J 2010;16:6.  Back to cited text no. 2
    
3.Carrion A. Chromoblastomycosis. Ann NYAcad Sci 1950;50:1255-82.  Back to cited text no. 3
    
4.Sayal SK, Prasad GK, Jawed KZ, Sanghi S, Satyanarayana S. Chromoblastomycosis. Indian J Dermatol Venereol Leprol 2002;68:233-4.  Back to cited text no. 4
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5.Menezes N, Varela P, Furtado A, Couceiro A, Calheiros I, Rosado L, et al. Chromoblastomycosis associated with Fonsecaea pedrosoi in a carpenter handling exotic woods. Dermatol Online J 2008;14:9.  Back to cited text no. 5
    

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Correspondence Address:
Aparajita Mishra
Plot No.879/112, Sector-6, C.D.A, Cuttack - 753 014, Orissa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77422

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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