Chromoblastomycosis Caused by Phialophora verrucosa in a Costa Rican Child with Skin Sequelae due to Snake Bite

Chromoblastomycosis is an implantation mycosis occurring among adults working in farms or with soil in tropical and subtropical areas worldwide. Fonsecaea pedrosoi is the most important agent in the tropical areas, while Phialophora verrucosa, although not a predominant agent, is found in the lowlands under the same conditions as the Fonsecae species. We present the case of a 10-year-old aboriginal boy, belonging to a soil worker family, with a history of extensive leg lesions and lymphedema secondary to a snake bite five years earlier. He was admitted to the National Children's Hospital (part of the Caja Costarricense del Seguro Social: the social security system in Costa Rica) with multiple verrucous confluent lesions on the ankle, some with dark coloration, and no other symptoms. Clinical suspicion of chromoblastomycosis was made and later confirmed by culture. Itraconazole was started showing clinical improvement. Chromomycosis, especially in the population with skin lesions or chronic tissue compromise, associated with the location and macroscopic findings, must be a part of our differential diagnosis. The story of an exposed pediatric patient to soil work and the history of an important leg swelling and skin disruption as sequelae of snake bite envenomation made this case unique. To our knowledge, there are no pediatric reports of Chromoblastomycosis in Latin America.