Wide geographical distribution and prolonged delay in diagnosis of chromoblastomycosis in the United States: A literature review

Chromoblastomycosis is an uncommon, but morbid fungal infection with poorly defined clinical characterization in the United States. This review aims to assess reported cases of chromoblastomycosis in the United States and describe the clinical presentation, diagnosis, and management. Chromoblastomycosis cases were included if confirmed by presence of characteristic, pigmented fungal cells on microscopy or histopathology. We identified 63 articles with 79 confirmed cases between 1915–2024. Mean age at diagnosis was 57.1 years; most patients were male. Many worked in manual labor, particularly in the agricultural and construction sectors. Identified cases spanned 20 states and Puerto Rico, with most in Texas, Louisiana, and Florida. Lesions primarily affected extremities, and the average diagnostic delay was 5.5 years, ranging from weeks to 40 years. This study found a wide geographical distribution of chromoblastomycosis in the United States. Clinicians should consider the diagnosis of chromoblastomycosis to prevent prolonged treatment delay and long-term morbidity. Prospective surveillance can monitor for changing trends in risk factors, geographical distribution, and causative fungi established in this literature review.