title: A case of relapsed chromoblastomycosis due to Fonsecaea monophora: antifungal susceptibility and phylogenetic analysis.
abstract: Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.
authors: Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400-2º andar, Porto Alegre, Rio Grande do Sul, CEP 90035-003, Brazil, tatidaboit@gmail.com.
authors: Tatiane Caroline
authors: TC
authors: Daboit
authors: Cibele Massotti
authors: CM
authors: Magagnin
authors: Daiane
authors: D
authors: Heidrich
authors: Mauricio Ramírez
authors: MR
authors: Castrillón
authors: Sandra Denise Camargo
authors: SD
authors: Mendes
authors: Gerson
authors: G
authors: Vettorato
authors: Patrícia
authors: P
authors: Valente
authors: Maria Lúcia
authors: ML
authors: Scroferneker
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D001203:Ascomycota / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D001938:Brazil; D002862:Chromoblastomycosis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D004357:Drug Synergism; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008828:Microbiological Techniques; D012340:RNA, Ribosomal, 5.8S / Q000235:genetics; D012008:Recurrence; D017422:Sequence Analysis, DNA
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D004275:DNA, Ribosomal; D021903:DNA, Ribosomal Spacer; D012340:RNA, Ribosomal, 5.8S
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