Facial Chromoblastomycosis with Visceral Involvement in Form of Extensive Abdominal Lymphadenopathy – A Case Report and Literature review

OBJECTIVES Chromoblastomycosis is a chronic granulomatous infection caused by a group of dematiaceous fungi and most commonly affects the lower extremities of individuals exposed to colonised mud or wood, such as agriculturists and ecotourists. It is most commonly limited to the skin and subcutaneous tissue but can be locally aggressive, leading to local lymphadenopathy, osteomyelitis and lytic bony lesions. Treatment modalities include surgical excision of the chromoblastomycosis lesion, oral antifungal agents or physical therapy, with the decision depending upon the size and severity of the lesion. CASE A 19-year-old male farmer presented to us with an erythematous plaque on his right cheek along with generalised jaundice and pruritus. The skin lesion was diagnosed as a chromoblastomycosis lesion on histopathological evaluation. Workup of his jaundice revealed extensive abdominal lymphadenopathy causing a compressive effect on the common hepatic duct. Histopathology of the lymph node taken from the porta hepatis confirmed systemic extension of fungal infection. He was treated with oral antifungals in combination with debulking abdominal surgery for his extensive abdominal lymphadenopathy causing obstructive jaundice. The patient responded well, with his liver function tests improving, and abdominal lymphadenopathy and facial lesion decreasing in size on follow-up. CONCLUSION The key learning points of this case report are that chromoblastomycosis, in addition to local invasion and lymphadenopathy, can cause visceral involvement as well, even though it is rare. In these cases, spread can be via lymphatic or hematogenous routes. In cases like ours, where visceral involvement was evident in the form of extensive abdominal lymphadenopathy, debulking surgery for symptomatic relief can be considered as part of the treatment regimen. Even in cases of chromoblastomycosis with visceral involvement, the role of oral antifungals remains justified, as both the chromoblastomycosis lesion and visceral features responded to antifungal therapy in our case.