Hidden under a Cauliflower-Like Skin Tumor: Chromoblastomycosis

Area of Science:

• Mycology
• Dermatology
• Pathology

Background:

• Chromoblastomycosis is an uncommon chronic fungal infection, typically affecting lower extremities in non-tropical regions.
• Fonsecaea pedrosoi is the most prevalent etiological agent.
• Clinical and histopathological misdiagnosis as squamous cell carcinoma is common due to similar presentations.

Purpose of the Study:

• To report a rare case of chromoblastomycosis with unusual characteristics.
• To emphasize the importance of considering chromoblastomycosis in the differential diagnosis of pigmented skin tumors.
• To highlight diagnostic challenges and the need for high clinical suspicion.

Main Methods:

• Case presentation of an 80-year-old patient with a recurrent skin tumor.
• Clinical and histopathological examination.
• Review of literature on chromoblastomycosis.

Main Results:

• The patient presented with a hyperpigmented, cauliflower-like skin tumor on the index finger stump.
• Initial diagnosis was recurrent squamous cell carcinoma, later corrected to chromoblastomycosis.
• The case exhibited unusual features: upper extremity localization, bone involvement, and occurrence in Switzerland without tropical travel history.
• The patient died from cardiogenic shock before treatment could be initiated.

Conclusions:

• Chromoblastomycosis can present atypically and be misdiagnosed, leading to delayed treatment.
• High clinical suspicion and inclusion in differential diagnoses are vital for managing pigmented skin tumors.
• This case underscores the possibility of chromoblastomycosis developing in non-endemic regions.