title: [Chromomycosis acquired in a non-tropical area: A case report].
abstract: BACKGROUND
  Chromomycosis, or chromoblastomycosis, is caused by cutaneous inoculation of dematiaceous fungi of telluric or plant origin. It is generally seen in tropical or subtropical zones. Treatment of the condition is known to be complex. Herein we report a case of chromomycosis contracted in a temperate region of Eastern Europe/Central Asia that was effectively treated with oral itraconazole and terbinafine in combination with cryotherapy.
  
  
  METHODS
  A 44-year-old immunocompetent male subject consulted for a lesion on the buttocks that he had sustained 16 years earlier, and which, although never previously treated, had only become troublesome within the last few months. The examination revealed a large erythemato-squamous plaque containing a heterogeneous infiltrate. The diagnosis was based upon biopsy, with histological examination revealing sooty mould ; culture of a second sample showed the causative agent to be Fonsecaea pedrosoi. After 30 months of treatment combining oral terbinafine at a very high dose (1000mg/day), topical terbinafine and adjuvant cryotherapy, considerable, though incomplete, improvement was obtained. Finally, combined use of terbinafine (500mg/day) and itraconazole (200mg/day) led to clinical and histological cure.
  
  
  CONCLUSIONS
  The possibility of acquiring chromomycosis other than in a tropical zone is slight but has nevertheless been described, particularly in Eastern Europe. In our patient, the exact source of contamination is unknown, although it may have been acquired through frequent horse-riding or use of saunas. This case confirms the efficacy of combined itraconazole and terbinafine against this condition, which is usually difficult to treat.
authors.affiliation: Service de dermatologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
authors.forename: M S
authors.initials: MS
authors.lastname: Ouédraogo
authors.affiliation: Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M-D
authors.initials: MD
authors.lastname: Vignon-Pennamen
authors.affiliation: Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Battistella
authors.affiliation: Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.affiliation: Service de mycologie parasitologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Feuilhade de Chauvin
authors.affiliation: Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France. Electronic address: antoine.petit@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Petit
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000302:isolation & purification; D001706:Biopsy; D002081:Buttocks / Q000473:pathology; D002862:Chromoblastomycosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D017679:Cryotherapy / Q000379:methods; D004359:Drug Therapy, Combination; D005061:Europe, Eastern; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D009281:Naphthalenes / Q000627:therapeutic use*; D000077291:Terbinafine; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D017964:Itraconazole; D000077291:Terbinafine
keywords: Asie centrale; Buttocks; Central Asia; Chromomycose; Chromomycosis; Europe; Fesse; Fonseca pedrosoi; Itraconazole; Terbinafine