62 year old man presented to us in 2003 with the above lesions over his left lateral thigh region of nine years duration.(The hyperpigmented areas are actually healed, photo taken 4 years after started on treatment).
The HPE was reported as:
Section shows skin tissue with central, irregular, benign, stratified squamous epithelial layer exhibiting acantholysis and mild pseudoepitheliomatous hyperplasia. The upper dermis shows presence of scattered, suppurative granulomas with neutrophils, multinucleated giant cells and ingested, pigmented "chest nut brown" rounded refractile fungal bodies. In addition, the dermis shows presence of numerous lymphocytes and plasma cells. Intrepretation: Chromoblastomycosis.
We repeated our own specimen and our HPE was reported as:
Section showing mild hyperplasia of squamous epithelium with foci of granulomatous inflammation in the superficial dermis. Scattered multinucleated cells are seen. The dermis is infiltrated by neutrophils and lymphoplasma cells. No fungal bodies identified in this specimen. Interpretation: Chronic granulomatous inflammation, consistent with fungal infection.
He was started on C. Itraconazole 200 mg OD till now. The lesion has improved more than 50%.
The question is, how long should we continue with the anti-fungal treatment?
