Chromoblastomycosis The granulomatous process shown in Fig. 7-1, which is variegated in color, is of 12 years’ duration. It started as a small nodule, developed slowly into a verrucous mass, and acquired satellite extensions. The condition, so reminiscent of a tuberculous process, is a deep fungal infection caused by the species of Phialophora, Fonsecaea, and Cladosporium, which are indigenous to parts of South America and other regions with warm climates. Lesions that are too large for surgical excision are treated with combinations of systemic flucytosine, amphotericin B, and ketoconazole.

Coccidioidomycosis This disease, caused by the dimorphic fungus Coccidioides immitis, is endemic to the southwestern United States and parts of Central and South America. Most individuals in those areas develop the disease as an inconsequential upper-respiratory infection.

Severe disseminated disease can follow pulmonary infection and may involve the skin. In Figs. 7-2 and 7-3, the lesions are typically abscesses, nodules, or verrucous and inflammatory plaques. Primary infection of the skin, which is rare, is accompanied by regional lymphadenopathy. Amphotericin B, with or without itraconazole or fluconazole, is the customary treatment.