Blastomycosis-like pyoderma: response to systemic retinoid therapy

Case Report: Successful Treatment of Chromoblastomycosis Caused by Fonsecaea monophora in a Patient with Psoriasis Using Itraconazole and Acitretin

Chromoblastomycosis is a worldwide chronic subcutaneous infection caused by dematiaceous fungi and clinically characterized by verrucous lesions. Herein, we report a rare case of chromoblastomycosis caused by Fonsecaea monophora in a 60-year-old male carpenter with a 40-year history of psoriasis from Shandong in northern China. A fungal infection coexisting with psoriasis presents a management dilemma. Our patient responded well to combined itraconazole and acitretin therapy and the lesions resolved completely after 1 month of treatment.

Pyoderma Vegetans – a Case Report

Pyoderma vegetans (PV) or blastomycosis-like pyoderma (BLP) is a chronic inflammatory disease, by some authors considered a rare variety of pyoderma gangrenosum (PG), and others describe it as a distinct entity. It commonly presents with verrucous plaques with multiple pustules. The etiology of this disease is unknown, but it has been connected with staphylococcal and streptococcal infections, inflammatory bowel disease, hematological diseases, primary immunodeficiency, alcoholism, and nutritional deficit. Here we present a 66-year-old, otherwise healthy female, with a 2-year-long history of well-defined, vegetative livid plaques with multiple pustules on the dorsal side of both hands. Histopathological analysis of the skin biopsy of the hand showed chronic inflammation and micro-abscesses, ruptured follicular cysts and follicular pseudoepitheliomatous hyperplasia. Treatment with anti-tuberculosis drugs and antibiotics showed to be ineffective, as well as the treatment with systemic corticosteroids, dapsone and cyclosporine. Itraconazole was given for its immunomodulatory effects and findings of Penicillium species in one of the swabs, which led to partial regression of lesions. Since the treatment did not lead to complete resolution, acitretin was indicated 3 months later, but the patient was lost to follow-up.

Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections

Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.

Pyoderma Vegetans Misdiagnosed as Verrucous Carcinoma

Pyoderma vegetans, a rare disorder of the skin, is considered a highly specific marker for inflammatory bowel disease, especially ulcerative colitis. It is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Here, the authors report the case of a 33-year-old man who was misdiagnosed as having verrucous carcinoma for 4 years.

Heterogeneity of blastomycosis-like pyoderma: A selection of cases from the last 35 years

Blastomycosis-like pyoderma is a form of pyoderma with variable clinical findings and histopathological features. We present a case series of 39 patients collected over a 35-year period to demonstrate its clinical features and histological findings. The most common clinical presentations found were solitary plaques, solitary nodules, sinuses, crypts, verrucous plaques and discharge, usually on sun-exposed skin. The most common histopathological findings were chronic granulomatous inflammation, suppurative inflammation, sinus and abscess formation, pseudoepitheliomatous hyperplasia, transepidermal elimination and scarring. We discuss its treatment and the recent literature that has focused on its response to acitretin.