Chromoblastomycosis as an endemic disease in temperate Europe: first confirmed case and review of the literature

Abstract

This study reports a case of a 56-year-old white male, retired coal-miner, diagnosed with chromoblastomycosis lasting 20 years. The infection site was the burnt skin of the back. For many years the patient had not undertaken any treatment believing that the lesion had been a burn scar. A gradual increase in lesion size prompted the patient to start therapy. The diagnosis was made by histopathological examination and mycological culture. Identification of the causative agent at the species level was achieved by sequence analysis of the internal transcribed spacer (ITS) region and D1/D2 domains of the 26S rDNA. To our knowledge, this is the first documented case of chromoblastomycosis caused by Fonsecaea monophora in temperate Europe, outside the endemic area for the disease. This finding is highly significant for understanding the routes of infection of chromoblastomycosis and radically revises the traditional view of the natural ecology of the etiological agents of the disease.

Chromoblastomycosis

“…A recent review of CBM in Europe revealed a total of 31 probable cases (149). The authors of that study suggested that the disease was considered to be autochthonous in some cases.…”

“…The authors of that study suggested that the disease was considered to be autochthonous in some cases. One of these cases was an infection acquired in a mine from locally harvested mine wood and caused by F. monophora (149). As CBM is uncommon in Europe, cases may have been misdiagnosed as cutaneous tuberculosis, squamous cell carcinoma, psoriasis, PHM, and sporotrichosis or other infectious and noninfectious conditions that may mimic CBM.…”

Exophytic and ulcerated nodule on the hand

“…It should be considered in travelers from endemic regions showing corresponding clinical signs [5]. Albeit rarely, autochthonous infections have also been described in Central Europe [6].…”

Exophytischer und ulzerierter Tumor an der Hand

“…Besonders bei Reisenden aus Endemiegebieten mit entsprechender Klinik gilt es daran zu denken [5]. Autochthone Infektionen in Zentraleuropa sind selten, werden aber beschrieben [6].…”