Chromoblastomycosis Treated With Posaconazole and Adjunctive Imiquimod: Lending Innate Immunity a Helping Hand

Chromoblastomycosis (CBM) is a difficult-to-treat, chronic fungal infection of the skin and subcutaneous tissue. The evidence base for treatment is scarce, with no standardized therapeutic approach. Chronicity of CBM infection is postulated to be due in part to a failure of host cell-mediated immunity to generate a proinflammatory response sufficient for fungal clearance. We present a case of a chronic chromoblastomycosis lesion of the hand present for nearly 4 decades, previously refractory to itraconazole monotherapy, that was successfully treated with a combination of posaconazole and adjunctive immunotherapy with topical imiquimod, a Toll-like receptor 7 agonist. Serial biopsies and images demonstrate the clinical and histopathological improvement of the lesion. Randomized trials of antifungal therapy with adjunctive imiquimod are warranted to determine whether a combination of antifungal and host-directed therapy improves outcomes for this neglected tropical mycosis.

Automated summary

Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue that is difficult to treat. The lack of standardized therapeutic approach and limited evidence for treatment options contribute to its chronicity. This case study presents a successful treatment of a chronic CBM lesion of the hand using a combination of posaconazole and topical imiquimod, an immune response modifier. The clinical and histopathological improvement of the lesion was demonstrated, suggesting the potential of antifungal therapy with adjunctive immunotherapy for CBM.