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Case Studies | Dermatology | India | Volume 11 Issue 12, December 2022
An Unusual Case of Lobomycosis in a Nonendemic Area and its Response to Therapy with Itraconazole and Clofazimine
Subodha Kumar Patjoshi | Dr. Sarada Mishra
Abstract: Lobomycosis is an endemic chronic deep fungal infection caused by Lacazia loboi an uncultivable fungus, occurring mostly in Amazon regions. Total 550 cases reported worldwide, 58.5% cases are from Brazil.1 60 cases of lobomycosis have been reported among the Kaiabi Indians, an ethnic population that lives in central Brazil. This disease is characterised by skin nodules and plaques resembling keloid. We report a case of 35 old female who presented with multiple skin coloured to pinkish nodular infiltrative lesion coalescing to form a large painless plaque, measuring 15 * 18cm*3cm over left thigh with left inguinal lymphadenopathy. The lesions started after a trauma to left thigh and progressed slowly since 2018 august. The initial lesions were pruritic papular in nature. A provisional diagnosis of Lobomycosis was made after clinical examination. Chromoblastomycosis, keloidal lepromatous leprosy, dermatofibrosarcoma purtuberans, verrucous cutaneous leishmaniasis were kept as differential diagnosises. To confirm the diagnosis routine investigations were sent which were within normal limit. X - ray and MRI showed no bony involvement. A 5mm punch biopsy was taken from an active lesion. H&E examination and calcofluor white stain showed granulomatous inflammation and fungal structures connected to each other by ill - defined tubule formation and diagnosis was suggestive of lobomycosis. Fungal Culture was negative. Following Treatment with oral itraconazole 200mg twice daily and clofazimine 100mg once daily visible clinical improvement seen after 3months and 70% improvement in the lesion seen after 6months of therapy. Timely treatment of lobomycosis with oral itraconazole and clofazimine lead to profound shrinkage in disease and diminished disease complication and minimise the requirement of surgical intervention. We report a case of lobomycosis because of its rarity and typical clinical presentation in our area and showing dramatic improvement with our treatment.
Keywords: Lobomycosis, thigh, itraconazole, clofazimine
Edition: Volume 11 Issue 12, December 2022,
Pages: 508 - 510