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. 2017 Jul-Aug;92(4):478-483.
doi: 10.1590/abd1806-4841.20175466.

Chromoblastomycosis: tissue modifications during itraconazole treatment

Kátia Sheylla Malta Purim  1 , Murilo Calvo Peretti  2 , José Fillus Neto  3 , Marcia Olandoski  4
Affiliations

Chromoblastomycosis: tissue modifications during itraconazole treatment

Kátia Sheylla Malta Purim et al. An Bras Dermatol. 2017 Jul-Aug.

Abstract

Background:: Histological and mycological changes during itraconazole use have not been totally established in chromoblastomycosis.

Objectives:: To evaluate tissue modifications in chromoblastomycosis carriers under itraconazole treatment.

Methods:: A histological retrospective study of 20 cases of chromoblastomycosis seen at the university hospital at the south of Brazil, during itraconazole 400 mg daily treatment. Patients were classified into two groups: plaque or tumor lesions, and underwent periodic evaluations every four months during three years. Hematoxylin-eosin stain was used to analyze epidermal modifications, inflammatory infiltrate and fibrosis, and Fontana-Masson stain for parasite evaluation.

Results:: Fontana-Masson stain was superior to hematoxylin-eosin stain in fungal count in the epidermis (mean difference=0.14; p<0.05). The most distinct mycosis tissue responses were registered in the dermis. Epidermal thinning, granulomatous infiltrate decrease or disappearance, fibrosis increase and quantitative/morphological changes occurred during treatment.

Study limitations:: Patients could not be located to have their current skin condition examined.

Conclusion:: Parasitic and tissue changes verified in this study can reflect the parasite-host dynamics under itraconazole action.

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Conflict of interest statement

Conflict of interest: None.

Figures

Figure 1
Figure 1
Clinical aspect of tumoral lesion with papillomatous surface, covered by black dots (arrow), on the dorsum of left foot
Figure 2
Figure 2
Positive direct mycological examination: brown spherical parasite elements, with and without septation, observed on tissue fragment with KOH (x1000)
Figure 3
Figure 3
A) Colony morphology of Fonsecaea pedrosoi in Sabouraud-dextrose-agar medium after 21 days of incubation; B) Microculture of Fonsecaea pedrosoi (X1000)
Figure 4
Figure 4
Pretreatment histological aspect: hyperkeratosis, pseudoepitheliomatous hyperplasia and dermal inflammatory infiltrate (Hematoxylin & eosin, X40)
Figure 5
Figure 5
A) Septated parasitic elements in the middle of the suppurative and granulomatous inflammatory infiltrate (Hematoxylin & eosin, X1000); B) Parasitic elements with signs of degeneration (arrow) in the middle of the inflammatory infiltrate (Hematoxylin & eosin, X40)
Figure 6
Figure 6
A) Septated parasitic elements (arrows) in the dermis (Fontana-Masson coloration, X40); B) Parasitic elements (arrows) in the dermis, delimited by reticulated area for counting (Hematoxylin & eosin, X40)
See this image and copyright information in PMC

References

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