Treatment of Severe Chromoblastomycosis Non Responsive with Itraconazole : A Case Report

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented (dematiaceous) fungi. Itraconazole is widely used as a first-line antifungal therapy due to its availability and effectiveness. However, in certain cases, patients may not respond to itraconazole, necessitating alternative treatments. This research aimed to analyze the clinical response to alternative antifungal therapy in a case of chromoblastomycosis unresponsive to itraconazole. This case report involves a 52-year-old male patient presenting with progressively growing, itchy, blackened lesions on the plantar surface extending to the left ankle for 10 years. The condition was preceded by a history of untreated clavus and thorn trauma from sharp twigs or grass. Periodic Acid-Schiff (PAS) staining confirmed the presence of Medlar bodies, establishing the diagnosis of chromoblastomycosis. The patient received itraconazole 200 mg twice daily for 6 months without clinical improvement. Treatment was subsequently switched to fluconazole 150 mg once daily for 4 months, resulting in significant clinical improvement. This case demonstrates that while itraconazole is the standard treatment for chromoblastomycosis, alternative antifungal agents such as fluconazole can be effective in cases of itraconazole resistance or non-responsiveness. The findings emphasize the importance of tailored therapy based on clinical response and suggest that fluconazole may be considered as a viable alternative in such cases.