Chromoblastomycosis with Squamous Cell Carcinoma

A 47 year old male patient had extensive verrucous lesions on the right upper limb for 33 years. One of the lesions-4eveloped ulceration which had not healed for6 years. A clinical diagnosis of chromoblastomycosis was confirmed histopathologically and mycologically, Cladosporium cladosporioides being the organism cultured. Combined treatment with amphotericin B and 5fluorouracil gave good response with most lesions resolving. A few verrucous plaques and the ulcer persisted. Biopsy from the ulcer revealed a low - grade squamous cell carcinoma which was treated with excision and grafting. A year later, the patient developed metastasis in the axillary lymph nodes which also showed fungal granuloma at the time of biopsy. The axilla was irradiated with 4500 rads and three courses of bleomycin injections were given. However, he died 10 months later following a massive bleed from an axillary vessel.