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    Cytodiagnostic Copper Pennies in Chromoblastomycosis: Through The Lens

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    Azmi Fadhlih
    [1] A 45-year-old male farmer presented with asymptomatic slowly progressive exophytic lesions on his left lower limb for 4 years. Examination showed multiple verrucous plaques and nodules with scaling and black dots. [2] Skin scraping revealed multiple round thick-walled brownish budding bodies resembling copper pennies, confirming the diagnosis of chromoblastomycosis. Tissue culture grew Fonsecaea pedrosoi as the causative agent. [3] The patient was started on oral itraconazole and showed a good response within 2 months, highlighting the value of the simple KOH skin scraping procedure for early diagnosis and treatment of chromoblast

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    Cytodiagnostic Copper Pennies in Chromoblastomycosis: Through The Lens

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    Azmi Fadhlih
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    [1] A 45-year-old male farmer presented with asymptomatic slowly progressive exophytic lesions on his left lower limb for 4 years. Examination showed multiple verrucous plaques and nodules with scaling and black dots. [2] Skin scraping revealed multiple round thick-walled brownish budding bodies resembling copper pennies, confirming the diagnosis of chromoblastomycosis. Tissue culture grew Fonsecaea pedrosoi as the causative agent. [3] The patient was started on oral itraconazole and showed a good response within 2 months, highlighting the value of the simple KOH skin scraping procedure for early diagnosis and treatment of chromoblast

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    IndianDermatolOnlineJ72145-3314968_091229

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    [1] A 45-year-old male farmer presented with asymptomatic slowly progressive exophytic lesions on his left lower limb for 4 years. Examination showed multiple verrucous plaques and nodules with scaling and black dots. [2] Skin scraping revealed multiple round thick-walled brownish budding bodies resembling copper pennies, confirming the diagnosis of chromoblastomycosis. Tissue culture grew Fonsecaea pedrosoi as the causative agent. [3] The patient was started on oral itraconazole and showed a good response within 2 months, highlighting the value of the simple KOH skin scraping procedure for early diagnosis and treatment of chromoblast

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    32 views2 pages

    Cytodiagnostic Copper Pennies in Chromoblastomycosis: Through The Lens

    Uploaded by

    Azmi Fadhlih
    [1] A 45-year-old male farmer presented with asymptomatic slowly progressive exophytic lesions on his left lower limb for 4 years. Examination showed multiple verrucous plaques and nodules with scaling and black dots. [2] Skin scraping revealed multiple round thick-walled brownish budding bodies resembling copper pennies, confirming the diagnosis of chromoblastomycosis. Tissue culture grew Fonsecaea pedrosoi as the causative agent. [3] The patient was started on oral itraconazole and showed a good response within 2 months, highlighting the value of the simple KOH skin scraping procedure for early diagnosis and treatment of chromoblast

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    [Downloaded free from http://www.idoj.in on Friday, May 18, 2018, IP: 110.136.130.

    244]

    Through the Lens

    Cytodiagnostic copper pennies in
    chromoblastomycosis
    Gopikrishnan Anjaneyan, Soumya Jagadeesan, Jacob Thomas

    Department of A 45‑year‑old male agriculturist presented subepidermal abscesses, thus confirming the
    Dermatology, to the dermatology outpatient clinic with diagnosis of chromoblastomycosis. Tissue
    Amrita Institute of asymptomatic slowly progressive exophytic fungal culture grew Fonsecaea pedrosoi, and
    Medical Sciences, Kochi,
    lesions over the left lower limb since 4 years. was identified as the etiological agent.
    Kerala, India
    Examination revealed multiple verrucous
    plaques and nodules with scaling and a Chromoblastomycosis, a subcutaneous mycoses
    few black dots on the surface of some is caused by dematiaceous fungi such as
    lesions [Figure 1]. He gave a history of trauma Phialophora verrucosa, F. pedrosoi, Fonsacea
    a few years back while farming, preceding the compacta, and Cladosporium carrionii. These
    onset of lesions. fungi have been isolated from wood and soil, and
    the infection usually results from trauma. Male
    Skin scraping with 10% potassium hydroxide agricultural workers from rural areas are most
    (KOH)–a simple office diagnostic procedure–was commonly affected.[1]
    performed, which showed multiple round
    thick‑walled brownish budding bodies Positive KOH smears and skin biopsies are
    resembling copper pennies (also known as confirmatory but diagnosis can be missed
    sclerotic/muriform/medlar bodies)  [Figure  2]. cytologically or histologically due to lack of
    L a t e r, h i s t o p a t h o l o g i c e x a m i n a t i o n “clinical suspicion” in many cases.[2] The main
    demonstrated similar pigmented sclerotic treatment options include long courses of
    Access this article online
    bodies within epithelioid granulomas, within systemic antifungals preferably itraconazole or
    Website: www.idoj.in Langhans giant cells and also in intra‑ and terbinafine combined with cryotherpy or local heat
    DOI: 10.4103/2229-5178.178085 therapy. Potassium iodide also has been used
    Quick Response Code: as a cost‑effective treatment option, especially
    in India.[3,4]

    We highlight the value of KOH scraping, this


    simple, quick, and easy‑to‑perform office

    Address for
    correspondence:
    Dr. Gopikrishnan
    Anjaneyan,
    Department of
    Dermatology, Amrita
    Institute of Medical
    Sciences (AIMS),
    B Block, Ponekkara,
    Kochi - 682 026,
    Kerala, India.
    E‑mail:
    drgopikrishnana@gmail. Figure 1: Chromoblastomycosis showing multiple
    verrucous plaques and nodules with scaling and a Figure 2: Skin scraping showing classical golden brown
    com
    few black dots septate “copper pennies” on 10% KOH mount

    Indian Dermatology Online Journal ‑ March‑April 2016 ‑ Volume 7 ‑ Issue 2 145


    [Downloaded free from http://www.idoj.in on Friday, May 18, 2018, IP: 110.136.130.244]

    Anjaneyan, et al.: Cytodiagnostic copper pennies

    procedure, which enabled us to initiate treatment on


    the same day without the typical delay associated with
    biopsy and culture reports. Our patient was started on oral
    itraconazole 100 mg twice daily and a good response was
    seen in 2 months [Figure 3].

    REFERENCES
    1. Hay RJ, Ashbee HR. Mycology. In: Burns T, Breathnach S, Cox N,
    Griffiths C, editors. Rook’s Textbook of Dermatology. 8th ed. Oxford:
    Wiley Blackwell; 2010. p. 36.75.
    2. Chavan SS, Kulkarni MH, Makannavar JH. ‘Unstained’ and
    ‘de stained’ sections in the diagnosis of chromoblastomycosis:
    A clinico‑pathological study. Indian J Pathol Microbiol
    2010;53:666‑71.
    3. Narendranath S, Sudhakar GK, Pai MR, Kini H, Pinto J, Pai MR.
    Safety and efficacy of oral potassium iodide in chromoblastomycosis.
    Int J Dermatol 2010;49:341‑3.
    4. C h a n d r a n   V, S a d a n a n d a n   S M , S o b h a n a k u m a r i   K .
    Chromoblastomycosis in Kerala, India. Indian J Dermatol Venereol
    Leprol 2012;78:728‑33.

    Cite this article as: Anjaneyan G, Jagadeesan S, Thomas J. Cytodiagnostic


    copper pennies in chromoblastomycosis. Indian Dermatol Online J
    2016;7:145-6.
    Source of Support: Nil, Conflict of Interest: None declared.
    Figure 3: Response to itraconazole after 2 months

    146 Indian Dermatology Online Journal ‑ March‑April 2016 ‑ Volume 7 ‑ Issue 2

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