A 37-year-old man presented to our clinic with a 12-year history of skin lesions on his right ear. Several painless skin-colored nodules with a smooth surface and a fibrous consistency were located on the helix and antihelix of the right pinna, giving the lesions a keloid-like appearance (Panels A and B). The patient had worked as a rubber collector for many years in Tefé, a city in the Brazilian Amazon region. A biopsy specimen obtained from a nodule revealed multiple dermal granulomas containing numerous round fungal structures that were consistent with Lacazia loboi (Panel C, Grocott–Gomori methenamine–silver nitrate stain). A tissue culture was negative for fungal growth. A diagnosis of lobomycosis was made. First described by Brazilian dermatologist Jorge Lobo in 1930, lobomycosis is a subcutaneous infection acquired after minor local trauma. Common in the Amazon rain forest region, this mycosis typically begins as a painless nodule with a keloid-like appearance. Surgical removal of the lesion is often performed to prevent or correct cosmetic disfigurement. In this case, the patient refused surgical treatment and had no response to ketoconazole therapy.
Fabio Francesconi, M.D.
Universidade Federal do Amazonas, Manaus, Brazil
fabiofrancesconi@globo.com
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