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MedPulse - International Medical Journal, ISSN 2348-2516 E-ISSN: 2348-1897

Volume 1, Issue 2, February 2014 pp 80-81

Case Report

Unusual Fungus Isolated in Leg Ulcer with Swelling

Ghosh Kumarjyoti¹, Ghosh Bharati², Roy Atanu³, Bhattacharya T. K.⁴, Ghosh A. J.⁵

Academic Editor : Dr. Bhanap P. L.

Abstract

Introduction: Chromoblastomycosis also known as chromomycosis, cladosporiosis, fonseca disease, pedroso disease or verrucose dermatitis (1) is a long term fungal infection of skin and subcutaneous tissue (2). The infection occurs most commonly in tropical and subtropical climates obtained in rural areas. It can be caused by many different types of fungi which become implanted under the skin often by thorns and splinters .Chromo mycosis spreads very slowly, is rarely fatal and usually has a good prognosis, but is difficult to cure. It is a under diagnosed and underreported public health problem. In India few cases have been reported till date, though it appears that with increased awareness, it is not that uncommon a problem especially ours being an agrarian society. The fungi most commonly observed in this infection are 1) Fonsecaea pedrosii 2) phialophora verrucosa 3) cladosporium carrionii and 4) Fonsecaea compacta. The mycosis spreads slowly, localized to skin and subcutaneous tissue. Multiple nodules appear often coalescing into a large plaque. The diagnosis depends on finding sclerotic cells or medlar bodies from KOH scrapping from the lesion. Histologically, it shows pigmented yeast resembling copper pennies. In this report two cases of relatively uncommon fungi were found among patients of verrucose leg swelling retractile in nature, non responding to antibiotics, with recurrent serous, non granular discharge within the span of six months in skin and Microbiology dept at Kisanganj, a rural area in Bihar. From November 2012 to April 2013 two patients presented with unusual verrucose swelling of feet with ulcer at Skin OPD and referred to Microbiology Dept. for isolation of causative organisms. KOH preparation from punch biopsy tissue showed sclerotic bodies under microscope. Anti fungal treatment gave encouraging result. Conclusion: Chromo mycosis is not frequently reported disease. It is believed to be a grossly under reported clinical condition. I n India with mostly an agricultural and rural background the prevalence of the disease is expected to be more than currently reported. In this report two cases of chromoblastomycosis are reported from rural settings in Bihar. With increasing awareness about this disease condition more cases should be searched especially with verrucous and non healing skin ulcers to diagnose this condition.