Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by melanized fungi belonging mainly to the family Herpotrichiellaceae. It occurs predominantly in tropical and subtropical regions and is the second most prevalent implantation mycosis worldwide. CBM mainly affects individuals whose occupational activities involve handling soil. In nature, CBM agents live saprobiotically, decomposing organic matter from various substrates originating from soil, plant debris and contaminated water; thus, accidental contact with this environment contributes to the development of the disease. A 56-year-old female patient, former rural worker, born in the state of Pará, initially presented a slightly pruritic papular lesion on the right lower limb 10 years earlier. After a few months, the papular lesion evolved into a verrucous plaque (3 cm in width and length) with mild pruritus. Biopsy of the lesion was performed and histopathology revealed brownish fungi, characteristic of CBM. Itraconazole (100 mg) twice daily was prescribed; however, the patient did not adhere to treatment and did not return for follow-up for several years. She now returns to restart CBM treatment, and physical examination shows chronic and extensive evolution of the disease involving the entire femoral region and part of the lower limb. Dermatologic examination shows an extensive verruciform plaque with darkened intervening areas, approximately 59 cm in width (femoral region) and 47 cm in length, associated with intense local pruritus and pain. Itraconazole (100 mg), two tablets twice daily, was prescribed again. CBM therapy is long and associated with low cure rates, mainly due to lack of adherence to treatment. The patient developed a severe form of the disease as a consequence of therapeutic failure at diagnosis, which may be associated with lack of awareness of CBM and its possible physical and emotional impacts. Therefore, early diagnosis, adherence to treatment, and educational, informative and preventive actions are essential to reduce and control the disease, especially in preventing more severe stages.
Junior et al. (2026) studied this question.