200 INFECTIONS' CAUSED BY MOLDS 



a case observed nearly ten years earlier. They assumed that the 

 fungus was the same as that isolated from the Boston case, but 

 further studies showed that this was not true. In 1922 Brumpt - 

 named the South American strain Hormodendrum Pedrosoi. The 

 disease has since been observed in many parts of the world. 



Clinical, In the first reported case of chromoblastomycosis the 

 lesion was on the buttocks. Lesions have been reported on the hands, 

 arms, face, neck, and shoulders, but the commonest location is on 

 the foot and lower leg. There is frequently a history of trauma such 

 as penetration by a thorn, and the disease is seen most often in bare- 

 footed agricultural laborers in tropical or subtropical countries. The 

 primary traumatic lesion may appear to heal and then ulcerate or, 

 in the absence of known injury, the primary lesion may be a pustule 

 or a papule which slowly increases in size. There may be consider- 

 able infiltration and some serous oozing in the early lesion. In most 

 cases the lesion soon becomes dry and somewhat verrucous, viola- 

 ceous, and sharply limited by a raised margin. In these early stages 

 there is such a close clinical resemblance to American blastomycosis 

 that a differential diagnosis cannot be made without laboratory 

 examination. However, the lesion does not continue to spread periph- 

 erally as in blastomycosis. Its surface becomes more verrucous 

 and raised and in many cases of some years' duration the continued 

 growth produces few or many large cauliflower-like masses on short 

 pedicels. The nodular surfaces of these tumors may be covered by 

 a smooth epidermis, but the skin is thin, and exposed lesions which 

 are bruised or rubbed frequently ulcerate. Other lesions are crusted 

 or rough and scaly. This is the classical appearance of the disease 

 but the character of the lesion is modified by its location. The 

 pedicellate lesions are seen rarely except on the lower leg and foot, 

 and not in the latter location if the pressure of a shoe limits their 

 development. 



Satellite lesions develop, probably as the result of autoinoculation 

 by scratching. There may be some spread by way of the lym- 

 phatics. In a few cases there appears to have been hematogenous 

 spread. The secondary lesions may be numerous and over a period 

 of several years involve most of the lower leg. Several of the re- 

 ported cases have been of 20 years' duration. 



The lesions are relatively painless unless there is ulceration and 

 secondary infection, but there may be severe pruritis. Blockage of 

 the lymphatics causes elephantiasis, and many patients complain 

 mostly of the disability caused by this deformity.^- ^' "• ^^' ^- 



