LOBOMYCOSIS

By Gary M. White, MD


Lobomycosis is infection by the fungus Loboa lobo.

Clinical

Multiple, discrete, firm, keloid-like nodules, commonly found on the distal legs, but also the arms, face, ears and trunk is characteristic. Papules, plaques, and verrucous or ulcerative lesions may occur as well. Sites of trauma are preferred. Rarely, SCC has developed in longstanding lesions [An Bras Dermatol 2013:88.293].

Histologically, one sees rounded fungi with a thick double wall, forming single chains.

Treatment

Surgical excision of all affected tissue is the best approach to therapy, if feasible. If untreated, lobomycosis usually runs a chronic course, but may regress or disseminate. One case of lobomycosis was successfully treated with posaconazole (400 mg 2 × a day for 27 month) with no recurrence after 5 years of follow up [Am J Trop Med Hyg 2013;88:1207-8]. Leprosy treatment with rifampicin, clofazimine, and dapsone has resulted in lobomycosis lesions decreasing in size [Rev Inst Med Trop Sao Paulo. 2010;52:273–278]. This may be followed with surgical excision. Cryotherapy has also been used, but multiple treatments are needed.

References

A 56 year-old Amazonian male farmer presented with multiple skin nodules in the left lower limb, which started 28 years ago after a penetrating trauma in the lower limb with the thorn of a plant. Am J Trop Med Hyg. 2015 Oct 7; 93(4): 675–676

Nodules of the ear. The buds classically form chains. N Engl J Med 2011; 364:e2 January 6, 2011

Derm101 Dermatol Pract Concept 2013;3(3):5

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