A 71-year-old woman, who had been taking prednisolone to treat myelodysplastic syndrome until quite recently, visited our hospital with the complaint of a erythematous plaque with brownish-black crusts on her left leg. The eruption appeared over one year earlier. The topical application of a steroid ointment prescribed by a doctor was not effective. At first, we suspected chromomycosis, but it was ruled out due to repeatedly negative KOH direct microscopic examinations. Later, a biopsy revealed fungal elements at the deep zone of the dermis. On Sabouraud medium, colonies of
Exophiala (E.) jeanselmei grew. We diagnosed chromomycosis caused by
E. jeanselmei and treated her with oral administration of itraconazole for three months; the lesion disappeared completely. It is said that
E. jeanselmei is less virulent and is associated with immunodeficiency. We validated these hypotheses with a review of reported cases of dematiaceous fungal infection in Japan for the recent 10 years. All the cases of chromomycosis caused by
E. jeanselmei had occurred in compromised patients.
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