Vitiligo-like depigmentation after chromoblastomycosis: a kind of postinflammatory depigmentation due to fungal infectio
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MYCOPATHOLOGIA IMAGE
Vitiligo-like depigmentation after chromoblastomycosis: a kind of postinflammatory depigmentation due to fungal infection
Received: 4 February 2020 / Accepted: 10 June 2020 / Published online: 19 June 2020 Ó Springer Nature B.V. 2020
Chromoblastomycosis, also known as chromomycosis, is one of the most prevalent implantation fungal infections, caused by brown-pigmented or melanized fungi. Chromoblastomycosis is mainly a tropical or subtropical disease that may affect individuals with certain risk factors around the world. Previous studies reported an association of chromoblastomycosis and vitiligo; however, the presence of anti-melanin antibodies in chromoblastomycosis patients is unknown. Most of the cases that were treated with itraconazole and healed, left depigmentation patches, where previous verrucous/plaque lesions occurred. A 61-year-old man presented with a 4-year history of a slow-growing plaque lesions on his right hand and arm (Fig. 1a). Skin scraping and histopathology both revealed the presence of muriform cells (Fig. 1b, c). The patient
had no history of vitiligo, autoimmune disorders or malignant melanoma. Fonsecaea pedrosoi was isolated, which was confirmed by slide culture and ITSPCR sequences (GenBank MT378334). The patient was diagnosed as chromoblastomycosis due to F. pedrosoi. After a 6-month combination therapy with itraconazole (200 mg/d, twice daily) and thermotherapy (approximately 44 °C, 30 min using exothermic padding, twice daily) and without any topical treatment, vitiligo-like depigmentation (Fig. 1d) developed. A previous study showed that emergency of vitiligo after chromoblastomycosis indicates that antimelanin antibodies have cross-reacted with human melanocytes. The variable-sized depigmentation macules resembled the primary morphology of chromoblastomycosis, indicating postinflammatory
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Mycopathologia (2020) 185:731–732
Fig. 1 a Slow-growing plaque lesion on his right hand and arm. Presence of muriform cells in direct scrapings (red arrow, 9 400) (b) and histopathology (yellow arrow, hematoxylin–
eosin staining, 9 400) (c). d Vitiligo-like depigmentation in place of the previous verrucous/plaque lesions after treatment. (Color figure online)
depigmentation. Furthermore, an additional biopsy of vitiligo-like depigmentation showed the absence of fungal elements, a loss of melanocytes and thickening of dermal collagen, which revealed that this phenomenon might be a postinflammatory depigmentation. While, vitiligo is an autoimmune disease mediated by autoreactive CD8? T cells which destroy melanocytes. In our opinion, postinflammatory depigmentation after chromoblastomycosis is not uncommon. In this case, we would recommend a diagnostic for a vitiligo-like depigmentation and not vitiligo.
Conflicts of interest conflict of interest.
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The authors declare that they have no
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