Mycobacterium marinum Co-infection Masquerading as Treatment-Resistant Chromoblastomycosis: A Diagnostic and Therapeutic Challenge in Cutaneous Co-infection
DOI:
https://doi.org/10.37275/bsm.v10i7.1624Keywords:
Chromoblastomycosis, Co-infection, Fish tank granuloma, Mycobacterium marinum, Nontuberculous mycobacteriaAbstract
Background: Co-infection of chromoblastomycosis and Mycobacterium marinum (fish tank granuloma) within a single cutaneous lesion is exceptionally rare and presents a formidable diagnostic challenge owing to overlapping clinical and histopathologic features. The chronic verrucous or nodular morphology, predilection for distal extremities, and aquatic exposure history common to both conditions can lead to misdiagnosis, prolonged ineffective therapy, and patient morbidity.
Case presentation: A 31-year-old Indonesian male with a fishkeeping hobby presented with a persistent erythematous plaque on the right middle finger, present since 2022, following a puncture injury sustained while collecting mosquito larvae and water fleas as fish food. He was initially diagnosed with chromoblastomycosis (Phialophora spp. on culture) in September 2023 and treated with itraconazole 200 mg daily and topical miconazole 2% for 48 weeks without resolution. Repeat biopsy in 2024 demonstrated negative periodic acid-Schiff and Ziehl-Neelsen stains but revealed non-caseating tuberculoid granulomas. Considering the patient's aquatic exposure, antifungal failure, and granulomatous histopathology, a diagnosis of fish tank granuloma due to M. marinum co-infection was established. Combination antimycobacterial therapy with rifampicin 600 mg and ethambutol 1500 mg daily produced clinical resolution at six-month follow-up.
Conclusion: This case underscores the necessity of considering M. marinum in patients with antifungal-refractory chronic skin lesions and aquatic exposure, and highlights the diagnostic value of repeat histopathology with directed staining when initial therapy fails.
Authors
- Stefanus Soewito Sutanto1
- Ni Luh Putu Ratih Vibriyanti Karna2*
- Herman Saputra3
- Robert Thiodorus1
- 1Dermatology and Venereology, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Indonesia
- 2Dermatology and Venereology, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Indonesia/Department of Dermatology and Venereology, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
- 3Pathology Anatomy, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Indonesia
Corresponding author Ni Luh Putu Ratih Vibriyanti Karna — ratihvibriyantikarna@gmail.com
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
Copyright and licensing
Copyright in each article remains with the author(s). Authors grant Bioscientia Medicina: Journal of Biomedicine and Translational Research a non-exclusive right of first publication and the right to identify itself as the original publisher. No exclusive transfer of copyright is required.
All articles are published under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0): https://creativecommons.org/licenses/by-nc-sa/4.0/. Users may copy, redistribute, remix, transform, and build upon the material for non-commercial purposes, provided appropriate attribution is given, a link to the license is supplied, changes are indicated, and adaptations are distributed under the same license.
The license applies to the article's scholarly content unless a credit line states otherwise. Third-party material may be subject to separate rights. Authors retain patent, trademark, moral, and research-data rights. The copyright year follows the article's publication date.
