title: Cutaneous Chromoblastomycosis Caused by Veronaea botryosa in a Patient with Pemphigus Vulgaris and Review of Published Reports.
abstract: Chromoblastomycosis and phaeohyphomycosis represent two poles of a disease spectrum caused by melanized fungi. Veronaea botryosa belongs to a small genus of saprobic fungi that occasionally cause human infections. To date, 11 cases of V. botryosa-induced cutaneous phaeohyphomycosis have been actually reported since 1990 after exclusion of 2 duplicated cases. We report the first case to our knowledge of cutaneous chromoblastomycosis caused by V. botryosa in a patient with pemphigus vulgaris. A 61-year-old man with 5-year history of pemphigus vulgaris and long-term treatment of corticosteroids and immunosuppressive agents developed multiple nodules on the dorsum of right wrist and hand after wrist trauma. Skin biopsy showed numerous brown muriform cells and a few septate hyphae in the tissue. Veronaea botryosa was isolated from the biopsy samples and then identified based on morphologic observation and DNA sequencing. The patient underwent immediate withdrawal of cyclophosphamide and gradual decrease in prednisone. Skin lesions healed after 5-month itraconazole therapy with an interval of 1-month terbinafine and one cycle of liquid nitrogen cryotherapy. Our results demonstrate that V. botryosa could induce both chromoblastomycosis and phaeohyphomycosis. Combined use of itraconazole and cryotherapy may be preferable to treat this infection.
authors.affiliation: Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, 524001, Guangdong, China.
authors.forename: Cheng-Yao
authors.initials: CY
authors.lastname: Zhu
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Yang
authors.forename: Ping
authors.initials: P
authors.lastname: Sheng
authors.forename: Wen
authors.initials: W
authors.lastname: Li
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Huang
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Fan
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000145:classification / Q000302:isolation & purification*; D001706:Biopsy; D002862:Chromoblastomycosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D017679:Cryotherapy; D003881:Dermatomycoses / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D006225:Hand / Q000473:pathology; D006651:Histocytochemistry; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D008969:Molecular Sequence Data; D009281:Naphthalenes / Q000627:therapeutic use; D010392:Pemphigus / Q000150:complications* / Q000188:drug therapy; D017422:Sequence Analysis, DNA; D012867:Skin / Q000382:microbiology / Q000473:pathology; D000077291:Terbinafine; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D009281:Naphthalenes; D017964:Itraconazole; D000077291:Terbinafine
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