Exophiala jeanselmei as a Rare Cause of Chromoblastomycosis in India: A Case Report

Abstract

Chromoblastomycosis (CBM) is a chronic cutaneous and subcutaneous fungal infection caused by certain dematiaceous fungi (usually Fonsecaea, Rhinocladiella, Phialophora,or Cladophialophora). Histologically, CBM is characterized by the presence of medlar bodies (also known as sclerotic body). Here, we report a case of CBM caused by Exophiala jeanselmei in an elderly patient with apparent no predisposing disease condition. Exophiala jeanselmei, a dematiaceous hyphomycete commonly found in soil, decaying vegetation and rotting wood is one of the lesser common organisms to be associated with CBM. On reviewing 169 cases published in English literature from India since 1957 until May 2016 by Aggarwal etal. only two cases were found to be caused due to Exophiala spp. while in majority of the cases Fonsecaea spp. (66.1%) was the etiological agent followed by Cladophialophora spp. (25.1%) and Phialophora spp.(3.9%).1progressive, cutaneous and subcutaneous fungal infection following the traumatic implantation of certain dematiaceous fungi. The disease has worldwide prevalence with predominant cases reported from humid tropical and subtropical regions of America, Asia, and Africa. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicions or clinical simulation of dermatological conditions. The infection is not uncommon in India and several case reports from the sub-Himalayan belt and western and eastern coasts of India have been published; however, very few have reviewed the cases. We reviewed 169 cases published in English literature from India during 1957 through May 2016, including 2 recent cases from our institute. A tremendous increase in the number of reported cases was noticed since 2012, since which, more than 50% of the cases had been published. A majority of the patients (74.1% Traumatic inoculation of E. jeanselmei may be the most common mode of acquisition leading to a variety of subcutaneous infections, including mycetoma, chromoblastomycosis, or phaeohyphomycosis. In immunosuppressed organ transplant recipients, E. Jeanselmei is the most common dematiaceous fungus associated with skininfections.2