Photodiagnosis and Photodynamic Therapy: Case Report

Photodiagnosis and Photodynamic Therapy 26 (2019) 13–14
Contents lists available at ScienceDirect
Photodiagnosis and Photodynamic Therapy

journal homepage: www.elsevier.com/locate/pdpdt
Case report
Successful treatment of chromoblastomycosis using ALA-PDT in a patient T

with leukopenia
⁎
Xiaowen Huang, Kai Han, Li Wang, Xiaoming Peng, Kang Zeng, Li Li
Department of Dermatology, Nanfang Hospital, Southern Medical University, 1838 North Avenue, Guangzhou 510515, China
A R T I C LE I N FO A B S T R A C T
Keywords: Chromoblastomycosis is a long-term fungal infection of the skin and subcutaneous tissue, usually presenting as
Chromoblastomycosis partial hypertrophic and warty plaques. Effective treatment is necessary to control the development of lesions,
ALA-PDT especially in patients with associated diseases. But till now, the treatment is still a challenge. Photodynamic
Anti-infective therapy (PDT) is an efficient and non-invasive treatment option. Here, we reported the case of a 52-year-old male
Leukopenia
with refractory chromoblastomycosis and leukopenia, who was successfully treated with 5-aminolevulinic acid-
based PDT (ALA-PDT). A complete cure, confirmed by clinical improvement and mycological detection, was
achieved after six sessions of every-other-week treatment. Post six months follow up no recurrence was observed.
The case here suggests that ALA-PDT is a valuable anti-infective therapy for refractory chromoblastomycosis.
1. Introduction mycological examination from the lesion, showing as typical round,

brown color, separated thick-walled cells, which was the recognizable
Chromoblastomycosis (CBM) is a chronic implantation fungal in- feature of CBM (Fig. 2b). Tissue biopsy conducted by culturing the
fection of the skin and subcutaneous tissue, caused by melanized or tissue in the Sabouraud’s dextrose agar plates showed slow growing,
brown-pigmented fungi [1]. The characteristic lesions of CBM usually velvet-like, dark brown colonies. Under microscopy, it was visible of
present as partial hypertrophic and warty plaques. We reported the case dark conidiophores and ovoid conidia located either at the end or at the
of a 52-year-old male with refractory CBM and leukopenia, who was side of conidiophore (Fig. 2c). DNA was extracted from the cultured
treated by 5-aminolevulinic acid-based photodynamic therapy (ALA- colonies, and the base sequence of ITS was identified, which was
PDT). After six sessions of ALA-PDT, the lesions had disappeared en- matched with Fonsecaea pedrosoi.
tirely. Considering the clinical manifestation and laboratory examinations,
The case here is evident to improve ALA-PDT is a valuable anti- the diagnosis of CBM and leukopenia was made. He underwent anti-
infective therapy for refractory CBM. fungal therapy (Itraconazole 400 mg/day) for two months, but without
visible improvement. Then we treated this patient with ALA-PDT for six
2. Case report sessions, with a one-week interval. The lesions were incubated with
freshly prepared 10% ALA cream (Shanghai Fudan-Zhangjiang Bio-
A 52-year-old man was admitted to our hospital with a complaint of Pharmaceutical Co. Ltd., Shanghai, China) for 4 h, and the
long-term verrucous hyperplasia on his left leg (Fig. 1a), which was 633 ± 10 nm red light with the intensity of 80–100 mW/cm2 was used
evolving over the last two years. Physical examination showed mul- as the irradiation source for 25 min. Six weeks later, the lesions ap-
tiple, scaly erythematous plaques with erosion and ulcer on the left peared as thinning plaques, with partial healing ulcers (Fig. 1b). A
shin, approximately 10 × 7 cm. The affected individual was also asso- complete cure, confirmed by clinical improvement and mycological
ciated with leukopenia, for the white cell count was less than 1 × 109/L detection, was achieved after six sessions of every-other-week treat-
for three times. The family history was unremarkable. He was received ment (Fig. 1c). Post six months follow up no recurrence was observed.
intermittent antibiotic treatment previously, but without significant The case here suggests that ALA-PDT is a valuable anti-infective therapy
improvement. The histological analysis showed hyperplasia and for refractory CBM.
chronic inflammation of the cutaneous, and dark-brown spores were in As one of the neglected tropical diseases, CBM is hard to cure and
the dermis (Fig. 2a). Muriform cells were observed through direct easy to be recurrent. Previously, we successfully treated two cases of
⁎
Corresponding author.
E-mail address: [email protected] (L. Li).
https://doi.org/10.1016/j.pdpdt.2019.02.013
Received 19 January 2019; Accepted 11 February 2019
Available online 12 February 2019
1572-1000/ © 2019 Published by Elsevier B.V.
X. Huang, et al. Photodiagnosis and Photodynamic Therapy 26 (2019) 13–14
Fig. 1. Lesions on the left thin before treatments with ALA-PDT (a), after three sessions of ALA-PDT (b), two months after six sessions of ALA-PDT (c).
Fig. 2. The biopsy specimen showed pseudoepitheliomatous hyperplasia and chronic granulomatous inflammation, and dark-brown spores in the upper dermis (H&E,
×40) (a). Direct mycological examination showed large and brown separated muriform cells from the lesion (KOH, ×400) (b). Brownish conidia from conidophore
in the slide culture of F. pedrosoi (×400) (c).
CBM by ALA-PDT combined with terbinafine 250 mg/day [2,3]. And in Foundation of China (No. 81601791).
the following studies, the fungicidal effect of ALA-PDT against the pa-
thogen was shown great promise [2]. And it also demonstrated that References
ALA-PDT inactivated F. monophora (one of the primary causative agent
of CBM) through directly killing and ROS-dependent oxidative damage [1] F. Queiroz-Telles, A.H. Fahal, et al., Neglected endemic mycoses, Lancet Infect. Dis.
in macrophages [4]. The present case applied ALA-PDT subsequent 17 (11) (2017) e367–e377.
[2] Y. Hu, X. Huang, S. Lu, et al., Photodynamic therapy combined with terbinafine
with the first-line antifungal drug, itraconazole, and showed a positive against chromoblastomycosis and the effect of PDT on Fonsecaea monophora in vitro,
effect. It’s the preferred therapy in refractory cases of CBM. Mycopathologia 179 (1–2) (2015) 103–109.
[3] Y. Yang, Y. Hu, J. Zhang, et al., A refractory case of chromoblastomycosis due to
Fonsecaea monophora with improvement by photodynamic therapy, Med. Mycol. 50
Declaration of interest (6) (2012) 649–653.
[4] X. Yi, C. Fransisca, Y. He, et al., Photodynamic effects on Fonsecaea monophora
None declared. conidia and RAW264.7 in vitro, J. Photochem. Photobiol. 176 (2017) 112–117.
Role of the funding source
This paper is supported by a grant from the National Natural Science
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Photodiagnosis and Photodynamic Therapy 26 (2019) 13–14

Contents lists available at ScienceDirect

Photodiagnosis and Photodynamic Therapy

Successful treatment of chromoblastomycosis using ALA-PDT in a patient T

1. Introduction mycological examination from the lesion, showing as typical round,

Role of the funding source

This paper is supported by a grant from the National Natural Science

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