Posters
Presenting Author Academic/Professional Position
Edwardo Abrego II
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Chromoblastomycosis (CBM) is a rare transcutaneous fungal infection, estimated to affect roughly 1 in 8 million Americans annually. CBM is considered an occupational disease in tropical climates for farm workers exposed to contaminated soil/plants. This infection has an insidious onset and can be recurrent, yielding verrucous/nodular lesions that can be mistaken with polymicrobial bacterial infections in diabetic patients. If not promptly diagnosed and treated, CBM can lead to malignant transformation, which places an emphasis on a thorough history as this can influence proper workup.
Case Presentation: A 66-year-old Hispanic insulin-dependent type II diabetic male presented to the emergency department with a chief complaint of pain, swelling, and fluid collection of the medial aspect of the left foot. These symptoms originated two weeks prior to presentation, with a 4-year history of a slowly enlarging mass involving the lateral, medial, and anterior portions of the left foot. He rated the pain as a 10/10, prompting arrival to the ED.
The patient noted a previous medical history of a similar episode 13 years ago, which was confirmed as a fungal infection via pathology from a surgical excision of a soft tissue mass. He was managed by an infectious disease specialist with a two-year course of an antifungal agent. He reports laboratory monitoring throughout this regimen but did not have any corresponding records. Despite resolution of the mass and surrounding pigmented lesions, he noted a brief relapse of small hyperpigmented lesions to the medial and lateral aspects of the same foot in early 2020. They initially resolved spontaneously, then recurred in 2021 with progression to skin thickening, hyperpigmentation, and formation of a mass at the first metatarsophalangeal joint. Social history is negative for travel, with the patient admitting to working in the fields 25 years ago. He does not walk barefoot outside.
He was admitted and underwent a CT with contrast and MRI of the left foot, which revealed a solid mass in the medial forefoot without evidence of abscess/osteomyelitis. A soft tissue mass and bone biopsy were performed, showing histopathology consistent with chromoblastomycosis. Infectious Disease (ID) was consulted, who recommended a 5-year regimen of an antifungal regimen. He was discharged with instructions to follow up with podiatry and ID within one week.
Conclusion: This case highlights the diagnostic challenges of chromoblastomycosis, particularly with insidious foot lesions and comorbid conditions like diabetes. The long latency between onset, recurrence, and diagnosis underscores the necessity to maintain a high index of suspicion in patients with prominent risk factors and clinical history. Prompt histopathological identification is paramount for diagnosis, which can lead to proper management and further prevention of sequelae such as malignant transformation.
Presentation Type
Poster
Recommended Citation
Abrego, Edwardo II; Ackerman, Laura; and Trujillo-Acosta, Mario, "Chromoblastomycosis of the Diabetic Foot: A Diagnostic Challenge" (2025). Research Colloquium. 37.
https://scholarworks.utrgv.edu/colloquium/2025/posters/37
Included in
Chromoblastomycosis of the Diabetic Foot: A Diagnostic Challenge
Background: Chromoblastomycosis (CBM) is a rare transcutaneous fungal infection, estimated to affect roughly 1 in 8 million Americans annually. CBM is considered an occupational disease in tropical climates for farm workers exposed to contaminated soil/plants. This infection has an insidious onset and can be recurrent, yielding verrucous/nodular lesions that can be mistaken with polymicrobial bacterial infections in diabetic patients. If not promptly diagnosed and treated, CBM can lead to malignant transformation, which places an emphasis on a thorough history as this can influence proper workup.
Case Presentation: A 66-year-old Hispanic insulin-dependent type II diabetic male presented to the emergency department with a chief complaint of pain, swelling, and fluid collection of the medial aspect of the left foot. These symptoms originated two weeks prior to presentation, with a 4-year history of a slowly enlarging mass involving the lateral, medial, and anterior portions of the left foot. He rated the pain as a 10/10, prompting arrival to the ED.
The patient noted a previous medical history of a similar episode 13 years ago, which was confirmed as a fungal infection via pathology from a surgical excision of a soft tissue mass. He was managed by an infectious disease specialist with a two-year course of an antifungal agent. He reports laboratory monitoring throughout this regimen but did not have any corresponding records. Despite resolution of the mass and surrounding pigmented lesions, he noted a brief relapse of small hyperpigmented lesions to the medial and lateral aspects of the same foot in early 2020. They initially resolved spontaneously, then recurred in 2021 with progression to skin thickening, hyperpigmentation, and formation of a mass at the first metatarsophalangeal joint. Social history is negative for travel, with the patient admitting to working in the fields 25 years ago. He does not walk barefoot outside.
He was admitted and underwent a CT with contrast and MRI of the left foot, which revealed a solid mass in the medial forefoot without evidence of abscess/osteomyelitis. A soft tissue mass and bone biopsy were performed, showing histopathology consistent with chromoblastomycosis. Infectious Disease (ID) was consulted, who recommended a 5-year regimen of an antifungal regimen. He was discharged with instructions to follow up with podiatry and ID within one week.
Conclusion: This case highlights the diagnostic challenges of chromoblastomycosis, particularly with insidious foot lesions and comorbid conditions like diabetes. The long latency between onset, recurrence, and diagnosis underscores the necessity to maintain a high index of suspicion in patients with prominent risk factors and clinical history. Prompt histopathological identification is paramount for diagnosis, which can lead to proper management and further prevention of sequelae such as malignant transformation.
