Holy Ametati
Semarang Indonesia Diponegoro University, Indonesia
Abstract Title:
Diagnostic pitfalls and therapeutic challenges of chromoblastomycosis: A case series from a tertiary referral hospital
Biography:
Dr. Holy Ametati, Sp. D.V.E., Subsp. D.T., FINSDV, FAADV received her medical degree from Universitas Diponegoro in 1999 and completed her specialization in Dermatology, Venereology, and Aesthetics in 2008. She is affiliated with Dr. Kariadi General Hospital and the Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia. Her academic interests include regenerative medicine, alopecia therapy, and dermatologic infections. She has published numerous scientific papers in national and international journals and has participated in various international academic programs in Spain, Turkey, the United States, and Italy.
Research Interests:
Chromoblastomycosis is a chronic deep fungal infection caused by pigmented fungi and is commonly associated with traumatic inoculation in individuals with frequent exposure to soil and plant materials. The disease often presents as slowly progressive verrucous plaques and may resemble other chronic infectious or granulomatous dermatoses, resulting in delayed diagnosis. We report four male patients aged 27–63 years with chronic verrucous lesions of the extremities and a history of repeated minor skin trauma. One patient had concurrent chromoblastomycosis and Tuberculosis Verrucosa Cutis (TVC), requiring anti-tuberculosis treatment before systemic antifungal therapy. Another patient presented with secondary bacterial infection. A case with culture-confirmed Cladosporium carrionii infection showed marked improvement following combination antifungal therapy. In contrast, one patient clinically resembled TVC and had a negative potassium hydroxide examination despite histopathological findings consistent with chromoblastomycosis. Histopathological examination identified characteristic muriform cells (“copper pennies”) in all cases and proved particularly valuable when clinical findings overlapped with other granulomatous diseases or when direct microscopy was inconclusive. These cases illustrate the diverse presentations of chromoblastomycosis and the diagnostic challenges encountered in routine practice. The disease may mimic other chronic dermatoses, coexist with additional infections, and occasionally escape detection on routine mycological examination. Histopathological evaluation was pivotal for diagnosis, particularly in cases with misleading clinical findings or negative direct microscopy. Early recognition and individualized treatment are important to improve outcomes and prevent prolonged disease progression in patients with chronic verrucous lesions in tropical settings.
