A 71-year-old man taking immunosuppressive medication for a renal transplant developed four chronic lower leg ulcers over 6 months. On dermatology consultation, incisional biopsy of a superior left leg ulcer (Figure, A) revealed the “copper penny” appearance of pigmented fungi (Figure, B) which is typical in chromoblastomycosis.1 Fonsecaea monophora was grown on culture. Usually seen in rural labourers in tropical and subtropical environments when black mould in the soil inoculates the skin, chromoblastomycosis typically presents as slow growing, painless, nodular, verrucous or plaque-like lower limb lesions.1,2 In this case, immunosuppression led to this infection and its atypical ulcer-like appearance. As excision was not possible, the dose of immunosuppressant drugs was reduced and terbinafine, itraconazole, teicoplanin and ciprofloxacin were used.
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- 1. Wolff K, Johnson R, Saavedra AP, Roh EK. Fitzpatrick’s color atlas and synopsis of clinical dermatology; 8th ed. New York, NY: McGraw-Hill; 2017.
- 2. Kauffman CA. Superficial mycoses and less common systemic mycoses. In: Kasper D, Fauci A, Hauser S, et al; editors. Harrison’s principals of internal medicine; 19th ed. New York, NY: McGraw-Hill; 2014.
We thank Mark Formby and Jim Scurry, from New South Wales Health Pathology North, for the histopathology and histopathology imaging, respectively.
No relevant disclosures.