title: Lobomycosis: A case from Southeastern Europe and review of the literature.
abstract: BACKGROUND
  Lobomycosis, also known as Jorge Lobo's disease, represents a rare chronic subcutaneous mycosis caused by the fungus Lacazia loboi, an organism that is found within lesions but has not been cultured to date. The natural reservoir of L. loboi is unknown but it is believed to be aquatic, or associated with soil and vegetation. More than 550 human cases have been reported, especially in patients with a history of travel or residence in endemic areas (Central and South America, particularly Brazil) or in communities along rivers.
  
  
  METHODS
  We describe a 64-year-old Greek female farmer living in a coastal region, who presented with an erythematous plaque on her left inner thigh resembling a keloid. The diagnosis was based on the triad: 1) absence of fungal growth in cultures, 2) positive direct microscopic examination of the lesion and 3) histopathology, all consistent with lobomycosis. Particularly, skin biopsy showed deep cutaneous fungal infection with granulomatous reaction. Fungal cells were found inside giant cells. The fungi were thick-walled with some budding, isolated or in short chains. Dermal fibrosis was present. Our patient had a medical history of common variable immunodeficiency but no history of travel to South or Central America. She probably acquired this rare infection by injury during her agricultural works.
  
  
  CONCLUSIONS
  Our case represents probably the first documented case of human lobomycosis in Southeastern Europe. This case is unusual due to the rarity of lobomycosis in Mediterranean countries, particularly in Southeastern Europe.
authors.affiliation: 2nd Department of Dermatology, Athens University School of Medicine, Attikon General University Hospital, Chaidari, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Papadavid
authors.forename: Maria
authors.initials: M
authors.lastname: Dalamaga
authors.forename: Irini
authors.initials: I
authors.lastname: Kapniari
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Pantelidaki
authors.forename: Sotirios
authors.initials: S
authors.lastname: Papageorgiou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Pappa
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Dervenoulas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Stavrianeas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Rigopoulos
keywords: Lacazia loboi; Lobo’s disease; immunodeficiency; infection; lacaziosis; lobomycosis; mycosis