Brown NEJM Chromoblastomycoses

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The new england journal of medicine

images in clinical medicine

Chromoblastomycosis

A B

67-year-old man was admitted to the hospital with a 12-year Michael Brown, M.R.C.P., Ph.D.

a history of swelling of his left leg. He had emigrated to the United Kingdom
London School of Hygiene
from Jamaica at the age of 31 years. When the patient was 41 years old, a golf- and Tropical Medicine
ball–sized nodule was excised from the dorsum of his left foot, and he was told he had London WC1E 7HT, United Kingdom
a fungal infection. At that time, he did not receive any further treatment. At the age of
55 years, the patient noticed that a nodule had developed on his left shin. He did not Geoffrey Pasvol, F.R.C.P., D.Phil.
seek medical attention until the lesion had spread and become so extensive that he was Imperial College
unable to walk (Panels A and B). A skin biopsy revealed a suppurative and granulomatous London W2 1PG, United Kingdom
infiltrate with clusters of brown fungal organisms (muriform cells), a finding diagnostic
of chromoblastomycosis (inset). A rhinocladiella species was cultured from skin scrap-
ings. The patient was treated for 24 months with itraconazole and terbinafine, which
resulted in improved mobility and substantial drying of the lesions, but warty changes,
hyperpigmentation, and lymphedema persisted.
Copyright © 2005 Massachusetts Medical Society.

n engl j med 352;20 www.nejm.org may 19, 2005 e19

The New England Journal of Medicine


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