Cutaneous lobomycosis: a delayed diagnosis.

The occurrence of lobomycosis outside central and South America is extremely rare. Herein we report 2 extraordinary cases of lobomycosis in 2 South African patients seeking medical attention at the Liverpool School of Hygiene and Tropical Medicine. The first patient presented with a 32-year history of a lesion on his left foot, with a further lesion subsequently developing on the right foot within the year. Six years ago he developed nontender keloid-like lesions on his left arm and on the face. The second patient is a 16-year-old black South African man who presented with a 2-year history of an ulcerating fungating tumor on his back. Microscopically, biopsies from both patients consisted of a diffuse granulomatous dermal inflammatory cell infiltrate composed of numerous multinucleate giant cells, and histiocytes, which contained rounded organisms with refractile walls, imparting a characteristic sievelike morphology; there were admixed acute and chronic inflammatory cells. Grocott's methenamine silver stain, and periodic acid Schiff (positive), demonstrated many uniform spherical to oval yeastlike organisms arranged singly or in small chains connected by thin tubular connections. In conclusion, we report 2 unique and exceedingly rare cases of cutaneous lobomycosis.