LobomycosisB48.00

Lobo, 1931

Very rare, chronic, deep mycosis of the skin and subcutis with prominent, papular, possibly ulcerative, encrusting, keloid-like nodules.

Loboa loboi; Paracoccidioides loboi; Lacazia loboi; the infection occurs through inoculation in case of small skin injuries or also through insect bites.

Very rare in Europe. Common disease in tropical rainforest areas of South America, especially in Brazil, Venezuela, Colombia, Central America, Guyana.

On uncovered body parts; no mucous membrane infestation, no infestation of the capillitium.

At the site of inoculation (usually after months) formation of a painless, indurated papule, which slowly develops into a rough, anular or map-like configured, large, bumpy plaque; also formation of confluent nodules. The infection spreads only per continuitatem. There is never lymphogenic or hematogenic spread. All symptoms have the keloid-like aspect, which has led to the name "keloid blastomycosis". The firm consistency of the skin lesions is caused by the densely packed fungal conglomerates in the dermis.

Epidermis with parakeratotic zones. In the dermis, hypertrophic hyalinized connective tissue bundles and granulomatous infiltrates with numerous yeast-like fungal cells, extracellular and in macrophages are visible. PAS- and Grocott-staining are appropriate.

Travel history, clinic, histology with evidence of yeast-like fungal cells, which can be visualized very well by means of PAS or Grocott staining.

Excision of isolated skin lesions. Effective chemotherapy is not known. In some patients an improvement was seen under clofazimine (e.g. Lamprene) in combination with itraconazole or 5-fluorouracil.