Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis. This infection is difficult to treat and there are limited therapeutic options, including terbinafine, itraconazole, and tioconazole. Classic treatment is administered for a long period of time, but some patients do not respond properly, and therefore, such therapeutic approaches possess low cure rates. Therefore, it is vital to develop new strategies for the treatment of CBM. In this regard, it has been observed that the association of immunomodulatory molecules such as glucan with therapy carried out with antifungal drugs improves cutaneous lesions in comparison to treatment with antifungal drugs alone, suggesting that drug association may be an interesting and significant approach to incorporate into CBM therapy. Thus, the aim of this work was to associate classical antifungal therapy with the adjuvants imiquimod and acitretin. In the present case, we reported a patient with extensive CBM caused by Fonsaecae pedrosoi, that affected an extensive area of the right leg, that was left without treatment for 11 years. He was treated with a classical combination of itraconazole and terbinafine via the oral route plus topical imiquimod and oral acitretin, as an adjuvant therapy. After five months of treatment, a significant regression of verrucous plaques was observed, suggesting that the use of these adjuvants combined with the classical antifungal drugs, intraconazole plus terbinafine, can reduce treatment time and rapidly improve the patient’s quality of life. This result confirms that the use of coadjuvant drugs may be effective in the treatment of this infectious disease.

: Paracoccidioidomycosis is an acute to chronic systemic mycosis caused by the fungi Paracoccidioides. Hypercalcemia is a rare and not fully understood presentation of this infection. We present a case report of paracoccidioidomycosis associated with hypercalcemia and acute kidney injury (AKI) in an immunocompetent patient. An immunocompetent 30-year-old man from Brazil presented with papular erythematous-violaceous skin lesions, disseminated lymphadenopathy, pain in the left hypochondrium, fever with night sweats, and loss of 25 kilograms in 5 months. The result of a biopsy of the lesions was positive for Paracoccidioides brasiliensis. Laboratory findings were high total calcium and 1,25-dihydroxy vitamin D, with low parathyroid hormone, low albumin, and AKI. Computed tomography scans revealed splenic infarcts without bone lesions. Treatment was performed with methylprednisolone and liposomal amphotericin B. Calcium levels and kidney function normalized within 20 days of hospitalization. The patient was discharged 49 days after admission. A follow-up 6 months later revealed total clinical and serological remission.

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface. The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.

Tinea nigra is a chronic fungal infection of the stratum corneum caused by the fungus Hortaea werneckii, clinically manifested by asymptomatic and hyperchromic macules ranging in color from light brown to black and affecting mainly the palmar and plantar areas. must be differentiated mainly from acral melanoma. It occurs mainly in South America (Brazil, Colombia, Venezuela), Central America and the Caribbean (Panama, Cuba), Asia (India, Japan, Sri Lanka) and the coastal regions of Africa and is uncommon in Europe, correlated with travel and immigration intercontinental. In relation to Brazil in the period 1916-2020, 203 cases were reported. We present a case of palmar tinea nigra in an adult patient with 3 months of evolution, diagnosed through clinical examination, direct mycological examination, Sabouraud agar culture, and dermatoscopy of the lesion was also performed. who fully responded to topical therapy with miconazole.

Mycetoma is a neglected disease that affects mainly the skin, but can progress to deep tissues and structures such as muscles and bones. Mycetoma can be caused by some bacterial (actinomycetoma) or fungal species (eumycetoma); furthermore, eumycetoma is estimated to account for 40% of all cases of mycetomas. Regardless of etiology, human infections occur after accidental implantation of etiological agents through the skin. In the present work, an immunocompetent patient without systemic comorbidity is reported to have exhibited a progressive increase of the left foot with multiple fistulas in the dorsum in the last 15 years, which emerged as a purulent secretion in the presence of yellowish grains. The patient reported that during a trip she suffered injuries in the affected foot. Histopathological study showed the presence of fungal grains, and the culture of skin fragments allowed the identification of fungal colonies exhibiting a dry, cream-coloured cerebriform morphology with a radiated peripheral edge. The micromorphology examination of the isolate demonstrated the presence of hyphae that swell and become multiseptate, budding cells, and lateral conidia were absent. MALD-TOF MS analysis led to the identification of Trichosporon asteroides as etiologic. Different treatment regimens were performed with no success, moderate improvement was observed with voriconazole, and treatment is still ongoing. This is the first case report to incriminate T. asteroides as an etiological agent of eumycetoma.