An Unusual Association between Chromoblastomycosis and Jorge Lobo’s Disease in the Same Patient from the Amazon Region

Abstract

A clinical case of co-infection Cladophialophora sp. and Lacazia loboi is described and in a same patient with an 18-year history of verrucous plaques and parakeloidal nodular lesions. A 50-yearold man, a laborer, living in the Anajás city, Para, Brazil (rural Amazon region), was seen at the Evandro Chagas Institute’s ambulatory. Histopathological analysis revealed intense hyperplasia and hyperkeratosis of the epidermis, sometimes showing well-circumscribed areas of an intraepidermal suppurative content intermingled with round and brownish structures. The papillary and reticular dermis was characterized by fibrosis and a granulomatous reaction consisting of lymphocytes, histiocytes and giant cells permeated by suppurative inflammatory foci and multiple round fungal structures mainly arranged amidst a neutrophilic inflammatory infiltrate. The clinical material collected from the lesion was submitted to direct mycological examination using 20% KOH solution and lactophenol cotton blue, which revealed the presence of yeast-like cells with a double membrane arranged in groups, a characteristic of Lacazia loboi, as well as sclerotic cells characteristic of chromoblastomycosis. Culture of the specimen on Mycosel agar and microculture on potato agar showed the typical morphology of Cladophialophora sp. The association of these two fungi causing lesions and inducing long-term disease may indicate a similarity in the characteristics of the habitat of these agents in the Amazon region.