Multiple confluent reddish nodules – Dermatology Practical & Conceptual Journal

A 48-year-old fisherman from Amazonas (north of Brazil) developed a small papule on the anterior left leg after a traumatic injury with a piece of wood 20 years ago. Over the course of years, multiple large, confluent, reddish to brownish nodules with eventual ulceration came into being on the left leg and extended to the left thigh. There was a solitary, domed-shaped nodule on the right arm.

Lobomycosis is a chronic infectious granulomatous disease of the dermis and hypodermis caused by the fungus Lacazia loboi [1,2]. There is no involvement of internal organs or external mucosas, but regional lymph nodes may be affected in 10–25% of the cases. [1] It mainly affects adult males living in densely forested tropical areas that are in close contact with nature, such as farmers, tree tappers, miners, and workers of aquatic environments [1,3]. The original description of the disease by Jorge Lobo dates from 1930 and most cases have been reported in the northern Brazil, other countries of the Amazon region, Central America and Mexico. There have also been sporadic reports of the disease in United States, Europe and Canada, but at least some of these patients had been in South or Central America. Two autochthonous cases were recently reported in South Africa