Jaleel Ameena, Celine Machiyanickel I, Sobhanakumari Kunjumani, Sadanandan Sadeep M, Shanimole Puthenpurayil E, Sobhana Surendran Susna
Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India.
Int J Dermatol. 2017 May;56(5):563-566. doi: 10.1111/ijd.13499. Epub 2017 Feb 23.
Mycetoma and chromoblastomycosis are subcutaneous fungal infections caused by pigmented fungi, common in the tropics and subtropics. Here we report a pregnant woman who presented with a swelling around the ankle joint which was clinically diagnosed as a case of mycetoma; however, further investigations revealed it to be a case of chromoblastomycosis.
24 year old primigravida presented with an indurated swelling around the ankle joint with multiple nodules and sinuses draining serosanguinous discharge. There was no improvement with antibiotic therapy or surgical debridement. Patient was investigated in detail including radiographs, KOH smear, pus culture and biopsy for histopathology and fungal culture.
o grains were identified from the discharge and KOH smear was negative for fungal elements. Pus culture revealed no bacterial growth. On the other hand, histopathology and fungal culture confirmed it to be a case of chromoblastomycosis caused by Fonsecaea pedrosoi. Treatment was initiated with terbinafine 250 mg daily, and patient showed excellent response within 6 months of therapy.
This unusual mycetoma-like presentation of chromoblastomycosis has not been previously reported in literature and may be attributed to the altered immune status in pregnancy. This should alert the clinician about the need to be vigilant of the atypical presentations of well-known dermatological conditions, especially in special situations like pregnancy.
足菌肿和着色芽生菌病是由色素真菌引起的皮下真菌感染，在热带和亚热带地区较为常见。在此，我们报告一名孕妇，其踝关节周围出现肿胀，临床诊断为足菌肿；然而，进一步检查显示这是一例着色芽生菌病。
一名24岁初产妇，踝关节周围出现硬结性肿胀，伴有多个结节和排出浆液性血性分泌物的窦道。抗生素治疗或手术清创均无改善。对患者进行了详细检查，包括X线片、氢氧化钾涂片、脓液培养以及组织病理学和真菌培养活检。
从分泌物中未发现颗粒，氢氧化钾涂片真菌成分阴性。脓液培养未发现细菌生长。另一方面，组织病理学和真菌培养证实这是一例由裴氏瓶霉引起的着色芽生菌病。开始每天用250毫克特比萘芬治疗，患者在治疗6个月内显示出良好反应。
这种不寻常的类似足菌肿表现的着色芽生菌病此前在文献中未见报道，可能归因于孕期免疫状态改变。这应提醒临床医生，尤其是在孕期等特殊情况下，要警惕知名皮肤病的非典型表现。
