From Scar to Infection: Cutaneous Chromomycosis under the Microscope

Abstract

Chromoblastomycosis is a chronic, granulomatous, and refractory fungal infection caused by melanin-producing fungi found in soil, wood, and vegetation in tropical and subtropical regions. It primarily affects male agricultural workers following trauma to the extremities. Its clinical presentation is polymorphic (nodular, verrucous, plaque-like, tumoral, and scar-like), making differential diagnosis difficult with other infectious and non-infectious conditions such as verrucous tuberculosis, leprosy, or squamous cell carcinoma. Diagnosis is based on the identification of muriform bodies through direct examination or fungal culture; molecular techniques help differentiate species, although they are often inaccessible in endemic areas. Treatment includes antifungal agents such as itraconazole and terbinafine, with complementary approaches like surgery or cryotherapy for small lesions. However, outcomes are limited and treatment tends to be prolonged.

We present the case of a 77-year-old male patient with a lesion initially classified as a scar, which was later confirmed to be Cladosporium spp., highlighting the importance of early diagnosis to prevent disease progression and complications.