Document Type : Case Study
Authors
1 Center of Medical Sciences, Department of Tropical Medicine, Federal University of Pernambuco (UFPE), Recife-PE 50740-600, Brazil
2 Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
Chromoblastomycosis (CBM) is a fungal disease, distributed in tropical and subtropical regions, affecting mainly rural workers. It is characterized by chronic skin lesions that may vary from nodular, tumorous, verrucous or plaque type. Associated constitutional symptoms are rarely found. The histological presentation may yield a pathognomonic feature, the Medlar (sclerotic) bodies, in which a typical brown to black pigment is depicted, explaining “copper pennies” as its alias. In this article, the case of a 56-year-old woman in the countryside of Brazil is reported; whose main complaint was a chronic leg ulcer for the past 8 years. On the left leg, a large, partially ulcerated plaque lesion was found. Microbiological cultures were positive for the pathogen. Histological analysis demonstrated pseudoepitheliomatous hyperplasia, lymphohistiocytic infiltrate and sclerotic bodies (“copper pennies”). CBM’s epidemiological panorama, once established uniquely by geographical distribution, is transitioning to a global health issue, influenced by immunosuppressive conditions, global warming and migration. This scenario demands CBM to be widely considered as a differential diagnosis and may represent a clinical challenge in regions whose professionals have little expertise in infectious tropical diseases.
Graphical Abstract
Keywords
Main Subjects
Selected author of this article by journal

Universidade Federal de Pernambuco
ORCID
Google scholar
Scopus
Open Access
This article is licensed under a CC BY License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit: http://creativecommons.org/licenses/by/4.0/
Publisher’s Note
CMBR journal remains neutral with regard to jurisdictional claims in published maps and institutional afflictions.
Letters to Editor
Given that CMBR Journal's policy in accepting articles will be strict and will do its best to ensure that in addition to having the highest quality published articles, the published articles should have the least similarity (maximum 18%). Also, all the figures and tables in the article must be original and the copyright permission of images must be prepared by authors. However, some articles may have flaws and have passed the journal filter, which dear authors may find fault with. Therefore, the editor of the journal asks the authors, if they see an error in the published articles of the journal, to email the article information along with the documents to the journal office.
CMBR Journal welcomes letters to the editor ([email protected]) for the post-publication discussions and corrections which allows debate post publication on its site, through the Letters to Editor. Critical letters can be sent to the journal editor as soon as the article is online. Following points are to be considering before sending the letters (comments) to the editor.
[1] Letters that include statements of statistics, facts, research, or theories should include appropriate references, although more than three are discouraged.
[2] Letters that are personal attacks on an author rather than thoughtful criticism of the author’s ideas will not be considered for publication.
[3] There is no limit to the number of words in a letter.
[4] Letter writers should include a statement at the beginning of the letter stating that it is being submitted either for publication or not.
[5] Anonymous letters will not be considered.
[6] Letter writers must include Name, Email Address, Affiliation, mobile phone number, and Comments
[7] Letters will be answered as soon as possible
- Queiroz-Telles F (2015) Chromoblastomycosis: a neglected tropical disease. Revista do Instituto de Medicina Tropical de São Paulo 57: 46-50. doi: https://doi.org/10.1590/S0036-46652015000700009
- Queiroz-Telles F, Esterre P, Perez-Blanco M, Vitale RG, Salgado CG, Bonifaz A (2009) Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment. Medical mycology 47 (1): 3-15. doi: https://doi.org/10.1080/13693780802538001
- Criado PR, Valente NYS, Brandt HRC, Belda Junior W, Halpern I (2010) Pedroso and Gomes' verrucous Dermatitis (Chromoblastomycosis): 90 years on and still among us. Anais Brasileiros de Dermatologia 85: 104-105. doi: https://doi.org/10.1590/S0365-05962010000100018
- Defendi L, Morgantetti G, De Medeiros G, Balancin M (2023) Chromoblastomycosis: a tropical–subtropical fungal disease with pathognomonic features not to be neglected in a global health scenario. Clin Res Commun 6 (1): 1-4. doi: https://doi.org/10.53388/CRC2023001
- Pedroso A, Gomes J (1920) Sobre quatro casos de dermatite verrucosa produzida por Phialophora verrucosa. An Paul Med Cir 11: 53-56. doi:
- Rudolph M (1914) Über die brasilianische “Figueira”(Vorläufige Mitteilung). Arch Schiffs Tropen-Hyg 18: 498-499. doi:
- Marques GF, Masuda PY, Sousa JMP, Barreto JA, Wachholz PA (2015) Clinical and demographic profile of chromoblastomycosis in a referral service in the midwest of São Paulo state (Brazil). Anais brasileiros de dermatologia 90: 140-142. doi: https://doi.org/10.1590/abd1806-4841.20153252
- Lu S, Lu C, Zhang J, Hu Y, Li X, Xi L (2013) Chromoblastomycosis in Mainland China: a systematic review on clinical characteristics. Mycopathologia 175: 489-495. doi: https://doi.org/10.1007/s11046-012-9586-z
- Chanda K (2021) An overview on the therapeutics of neglected infectious diseases—Leishmaniasis and Chagas diseases. Frontiers in Chemistry 9: 622286. doi: https://doi.org/10.3389/fchem.2021.622286
- Avelar-Pires C, Simoes-Quaresma JA, Moraes-de Macedo GM, Brasil-Xavier M, Cardoso-de Brito A (2013) Revisiting the clinical and histopathological aspects of patients with chromoblastomycosis from the Brazilian Amazon region. Archives of medical research 44 (4): 302-306. doi: https://doi.org/10.1016/j.arcmed.2013.04.008
- Gomes RR, Vicente VA, Azevedo CMd, Salgado CG, da Silva MB, Queiroz-Telles F, Marques SG, Santos DW, de Andrade TS, Takagi EH (2016) Molecular epidemiology of agents of human chromoblastomycosis in Brazil with the description of two novel species. PLoS neglected tropical diseases 10 (11): e0005102. doi: https://doi.org/10.1371/journal.pntd.0005102
- Jiang N, Voglmayr H, Piao CG, Li Y (2021) Two new species of Diaporthe (Diaporthaceae, Diaporthales) associated with tree cankers in the Netherlands. MycoKeys 85: 31-56. doi: https://doi.org/10.3897/mycokeys.85.73107
- Kokina A, Tanilas K, Ozolina Z, Pleiko K, Shvirksts K, Vamza I, Liepins J (2021) Purine Auxotrophic Starvation Evokes Phenotype Similar to Stationary Phase Cells in Budding Yeast. Journal of fungi (Basel, Switzerland) 8 (1). doi: https://doi.org/10.3390/jof8010029
- Schroeder K, Heinrich K, Neuwirth I, Jonas K (2021) The Chaperonin GroESL Facilitates Caulobacter crescentus Cell Division by Supporting the Functions of the Z-Ring Regulators FtsA and FzlA. mBio 12 (3). doi: https://doi.org/10.1128/mBio.03564-20
- Xie XX, Nuerla A, Balati M, Zhong NF, Li NX (2022) Typical Pesticide Residues and Their Risk Assessment in Farmland Environment of Different Plant Types in Shaya County, Xinjiang. Huan jing ke xue= Huanjing kexue 43 (8): 4154-4165. doi: https://doi.org/10.13227/j.hjkx.202110020
- Correia RTM, Valente N, Criado PR, Martins JEdC (2010) Chromoblastomycosis: study of 27 cases and review of medical literature. Anais brasileiros de dermatologia 85: 448-454. doi: https://doi.org/10.1590/S0365-05962010000400005
- Bui AQ, Espana EM, Margo CE (2012) Chromoblastomycosis of the conjunctiva mimicking melanoma of the ciliary body. Archives of Ophthalmology 130 (12): 1615-1617. doi: https://doi.org/10.1001/archophthalmol.2012.1573
- Roy AD, Das D, Deka M (2013) Chromoblastomycosis–A clinical mimic of squamous carcinoma. The Australasian Medical Journal 6 (9): 458. doi: https://doi.org/10.4066%2FAMJ.2013.1806
- Queiroz-Telles F, de CL Santos DW (2013) Challenges in the therapy of chromoblastomycosis. Mycopathologia 175: 477-488. doi: https://doi.org/10.1007/s11046-013-9648-x
- Falci R, Queiroz-Telles F, Fahal A, Falci D, Caceres D, Chiller T, Pasqualotto A (2017) Fungal infections 4 neglected endemic mycoses. Lancet Infect Dis 17: e367-e377. doi: https://doi.org/10.1016/S1473-3099(17)30306-7
- Santos DWC, de Azevedo CdMPeS, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, Denning DW, Colombo AL (2021) The global burden of chromoblastomycosis. PLoS Neglected Tropical Diseases 15 (8): e0009611. doi: https://doi.org/10.1371/journal.pntd.0009611
- Coelho RA, Alves GM, Figueiredo-Carvalho MHG, Almeida-Silva F, de Souza GR, Lourenço MCdS, Brito-Santos F, Amaral ACF, Almeida-Paes R (2022) New possibilities for chromoblastomycosis and phaeohyphomycosis treatment: identification of two compounds from the MMV Pathogen Box® that present synergism with itraconazole. Memórias do Instituto Oswaldo Cruz 117: 1-9. doi: https://doi.org/10.1590/0074-02760220089
- Antonello VS, Silva MCAd, Cambruzzi E, Kliemann DA, Santos BR, Queiroz-Telles F (2010) Treatment of severe chromoblastomycosis with itraconazole and 5-flucytosine association. Revista do Instituto de Medicina Tropical de São Paulo 52: 329-331. doi: https://doi.org/10.1590/S0036-46652010000600008
- Padda IS, Parmar M (2022) Flucytosine. In: StatPearls [Internet]. StatPearls Publishing; Copyright © 2022, StatPearls Publishing LLC, p Bookshelf ID: NBK557607
- Bazaliński D, Przybek-Mita J, Barańska B, Więch P (2017) Marjolin’s ulcer in chronic wounds–review of available literature. Contemporary Oncology/Współczesna Onkologia 21 (3): 197-202. doi: https://doi.org/10.5114/wo.2017.70109
- Minotto R, Bernardi CDV, Mallmann LF, Edelweiss MIA, Scroferneker ML (2001) Chromoblastomycosis: a review of 100 cases in the state of Rio Grande do Sul, Brazil. Journal of the American Academy of Dermatology 44 (4): 585-592. doi: https://doi.org/10.1067/mjd.2001.112220
- Skupsky H, Junkins-Hopkins J (2017) Counterfeit pennies: distinguishing chromoblastomycosis from phaeohyphomycotic infections. The American Journal of Dermatopathology 39 (6): 485-487. doi: https://doi.org/10.1097/DAD.0000000000000679
- Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M (2014) Chromoblastomycosis. Adv Dermatology Allergol 31: 310-321. doi: https://doi.org/10.5114/pdia.2014.40949
- Chang CC, Crane M, Zhou J, Mina M, Post JJ, Cameron BA, Lloyd AR, Jaworowski A, French MA, Lewin SR (2013) HIV and co‐infections. Immunological reviews 254 (1): 114-142. doi: https://doi.org/10.1111/imr.12063
- Silverberg MJ, Chao C, Leyden WA, Xu L, Tang B, Horberg MA, Klein D, Quesenberry Jr CP, Towner WJ, Abrams DI (2009) HIV infection and the risk of cancers with and without a known infectious cause. Aids 23 (17): 2337-2345. doi: https://doi.org/10.1097/qad.0b013e3283319184
- George MP, Masur H, Norris KA, Palmer SM, Clancy CJ, McDyer JF (2014) Infections in the immunosuppressed host. Annals of the American Thoracic Society 11 (Supplement 4): S211-S220. doi: https://doi.org/10.1513/annalsats.201401-038pl
- Soverow JE, Wellenius GA, Fisman DN, Mittleman MA (2009) Infectious disease in a warming world: how weather influenced West Nile virus in the United States (2001–2005). Environmental health perspectives 117 (7): 1049-1052. doi: https://doi.org/10.1289/ehp.0800487
- Tuite AR, Greer AL, Fisman DN (2013) Effect of latitude on the rate of change in incidence of Lyme disease in the United States. Canadian Medical Association Open Access Journal 1 (1): E43-E47. doi: https://doi.org/10.9778/cmajo.20120002
- Lopez-Velez R, Huerga H, Turrientes M (2003) Infectious diseases in immigrants from the perspective of a tropical medicine referral unit. The American journal of tropical medicine and hygiene 69 (1): 115-121. doi:
- Castelli F, Sulis G (2017) Migration and infectious diseases. Clinical Microbiology and Infection 23 (5): 283-289. doi: https://doi.org/10.1016/j.cmi.2017.03.012
- Pareek M, Greenaway C, Noori T, Munoz J, Zenner D (2016) The impact of migration on tuberculosis epidemiology and control in high-income countries: a review. BMC medicine 14: 1-10. doi: https://doi.org/10.1186/s40985-017-0065-4