Chromoblastomycosis: Case Report of an Old Unknown Disease

Chromoblastomycosis is a polymorphic subcutaneous mycosis caused by dematiaceous fungi of the family Herpotrichiellaceae, usually acquired through cutaneous trauma, and is currently considered a neglected tropical disease by the World Health Organization. It mainly affects the lower limbs, with initial macular lesions that may evolve into verrucous, nodular or plaque forms, and can lead to complications such as lymphedema, elephantiasis, ankylosis and even skin cancer. Early diagnosis is essential, as the disease may be resistant to treatment and cause permanent sequelae. This case report aims to discuss the consequences of failure in recognizing and properly following chromoblastomycosis, highlighting the diagnostic and therapeutic challenges faced by professionals unfamiliar with the disease. We report a 69-year-old male patient from Piauí with a history of verrucous lesions on the right foot for about three decades, initially considered a mycosis related to his work in mining. Over the years, he underwent several empirical treatments, including presumptive diagnoses of leprosy and leishmaniasis, without success. Between 2009 and 2016, skin biopsy and culture of the lesions had already confirmed the diagnosis of chromoblastomycosis. During this period he had several hospitalizations, irregular follow-up by different specialists, and multiple treatment regimens including itraconazole for up to 12 weeks; however, the lesions continued to progress and compromised limb function. In 2025, the patient presented with severe infectious involvement of the right leg, with signs of tissue failure and myiasis, which led to the need for amputation. He received in-hospital antifungal therapy with voriconazole for 3 weeks and was later maintained on oral itraconazole combined with flucytosine. He remained clinically stable but with significant functional and psychological impact. This case demonstrates the importance of broader awareness of chromoblastomycosis regarding early diagnosis, appropriate treatment and continuous follow-up to avoid severe and mutilating complications. Better training of health professionals about the disease is essential. Mandatory notification of the cases, which currently does not exist, could facilitate epidemiologic surveillance and active case finding, contributing to more effective management and, consequently, reducing morbidity, improving quality of life and preventing permanent sequelae in affected patients.