A 42-year-old Chilean woman, with no relevant morbid history, who had traveled every two months and for many years U.A. and Center, respectively.
presented three asymptomatic maculae, coffee color in the sole of the feet.
Physical examination revealed three 2-3 cm spots, light brown color, with pigmentation and irregular shape, well-defined borders, non-squamative and without inflammatory signs.
Two lesions were located in the plant of the right foot and one in the plant of the left foot.
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Dermoscopy showed a non-pigmented lesion composed of a tenuous homogeneous brown color, with multiple small rows of coffee tone.
In some areas the pigmentation was fragmented leaving spaces without pigment.
Pigmentation was mainly located in the papillary ridges.
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Mycological examinations were requested (direct microscopic examination and culture), for which corneal scabs were extracted from the three lesions by scraping with sterile scalpel, after cleaning the area with alcohol 70%.
Direct mycological examination revealed the presence of a drop of Clorazol Black-E ® (Chlorazolo fungal stain, Delasco, Council B1501) deposited between lamina and laminilla.
We observed abundant branched septate hyphae, both hyaline and dematiaceous.
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It was cultured in three different media: Sabouraud dextrosa agar modified, Sabouraud agar with cycloheximide and Lactricamera agar, where they were inoculated (surface and depth)
The plates were implanted at 30°C in a moist environment for one month.
After 10 days, small, brownish-brown colonies were observed, which became black and white on days.
After 30 days of inoculation, the colonies were black and grayish on the reverse side of the Sabouraud agar plate, with no diffuse pigment.
On its surface they had small velosities tertied.
During the course of this observation, from one of these colonies, a microcultivation (cultivated on slide) was performed, where septate dematiaceous hyphae and coffee-like yeasts were observed.
The initially hyaline conidia then became green olive or coffee.
With the macroscopic and microscopic findings we identified the presence of Hortaea werneckii.
In addition, physiological growth tests were performed on some colonies in order to differentiate the species.
Tolerance was demonstrated in media with 10% NaCl, lactose, nitrate and nitrite assimilation and growth inhibition at 37°C.
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The patient was treated with itraconazole 100 mg daily orally for four weeks, with complete remission of the lesion to treatment.
