Chromoblastomycosis successfully treated with the combination of itraconazole and 5-flucytosine

Chromoblastomycosis (CBM) is a fungal disease, distributed in tropical and subtropical regions, affecting mainly rural workers. It is characterized by chronic skin lesions that may vary from nodular, tumorous, verrucous or plaque type. Associated constitutional symptoms are rarely found. The histological presentation may yield a pathognomonic feature, the Medlar (sclerotic) bodies, in which a typical brown to black pigment is depicted, explaining “copper pennies” as its alias. In this article, the case of a 56-year-old woman in the countryside of Brazil is reported; whose main complaint was a chronic leg ulcer for the past 8 years. On the left leg, a large, partially ulcerated plaque lesion was found. Microbiological cultures were positive for the pathogen. Histological analysis demonstrated pseudoepitheliomatous hyperplasia, lymphohistiocytic infiltrate and sclerotic bodies (“copper pennies”). CBM’s epidemiological panorama, once established uniquely by geographical distribution, is transitioning to a global health issue, influenced by immunosuppressive conditions, global warming and migration. This scenario demands CBM to be widely considered as a differential diagnosis and may represent a clinical challenge in regions whose professionals have little expertise in infectious tropical diseases.