Chromoblastomycosis (CBM) is a chronic subcutaneous fungal infection that is still poorly described in transplant patients. We report an uncommon case of CBM in a heart transplant recipient. A 60-year-old male patient from Minas Gerais, Brazil, had a 3-month history of a skin lesion on the right forearm. He denied any history of local trauma or associated systemic signs and symptoms. He had undergone heart transplantation 3 years earlier and was on triple immunosuppressive therapy with tacrolimus, mycophenolate and prednisone. Physical examination revealed a brownish plaque about 3 cm in diameter, with a smooth surface, black dots, well-defined borders and slight erythema on the right forearm. Complete excision of the lesion was performed and the specimen was sent for histopathology, which showed a dense lympho-histioplasmacytic infiltrate, interspersed with neutrophils and multinucleated giant cells engulfing round, brownish structures, suggestive of CBM. After diagnosis, treatment with itraconazole 400 mg/day was started with good tolerability. After three months of treatment, due to other transplant-related complications, the patient required nasoenteral tube feeding. Considering the risk of tube obstruction by itraconazole, oral terbinafine 1 g/day was chosen and maintained until the end of treatment, totaling 18 months. During treatment and after antifungal discontinuation, there were no signs of recurrence and the patient showed complete clinical improvement. This report describes a rare case of CBM in a heart transplant recipient, with favorable clinical evolution after prolonged antifungal therapy combined with complete excision of the lesion. To date, this is the second reported case of CBM in a heart transplant recipient. This case highlights the need for high clinical suspicion and histopathological confirmation in the presence of suggestive skin lesions. Unfortunately, species identification was not possible, as the sample was not sent for fungal culture. Including CBM in the differential diagnosis of dermatoses in immunocompromised patients is essential to ensure timely treatment, avoid complications, and expand clinical knowledge.
Cardoso et al. (Sun,) studied this question.