[Generalized chromomycosis caused by Phialophora verrucosa]

Area of Science:

• Dermatology
• Mycology
• Infectious Diseases

Background:

• Chromomycosis is a chronic fungal skin infection typically presenting as verrucous lesions on exposed areas.
• Phialophora verrucosa is a rare causative agent of chromomycosis.

Observation:

• A 42-year-old woman presented with generalized chromomycosis, featuring erythematous keratotic nodules, ulcerative lesions, and unusual umbilical/molluscoid lesions on her back.
• The patient had insulin-dependent diabetes but no history of injury or travel to endemic areas for leishmaniasis.
• Histopathology revealed epithelioid giant-cell granuloma; mycological study identified fumagoid bodies and isolated P. verrucosa.

Findings:

• The case demonstrates an unusual clinical presentation and extensive lesions of chromomycosis.
• Isolation of P. verrucosa, a rare species, was confirmed (second report in Morocco).
• Standard treatments (terbinafine, clarithromycin) were ineffective, necessitating combination therapy (itraconazole, amphotericin B).

Implications:

• This case highlights the diagnostic and therapeutic challenges associated with generalized chromomycosis caused by rare fungal species.
• It underscores the importance of considering unusual presentations and rare pathogens in chronic skin infections.
• Effective management may require aggressive combination antifungal therapy.