Report of the first human case of lobomycosis in the United States

We describe the first human case of lobomycosis caused by Lacazia loboi in a 42-year-old white male resident of Georgia. The patient had traveled to V enezuela 7 years earlier, where he had planned to rappel down Angel Falls i n Canaima. Although he never actually rappelled the falls, he did walk unde r the falls at least three times, exposing himself to the high water pressu res of the falls. He noticed a small pustule with surrounding erythema deve loping on the skin of his right chest wall. The lesion gradually increased in size and had an appearance of a keloid. For cosmetic reasons, the patien t sought medical treatment to remove the lesion. After an uncomplicated exc ision of the lesion, the patient recovered completely. The excised tissue w as fixed in formalin for pathologic examination. Tissue sections stained by hematoxylin and eosin, periodic acid-Schiff stain, and Gomori methenamine silver stain procedures showed numerous histiocytes, multinucleated giant c ells, and numerous globose or subglobose, lemon-shaped cells producing mult iple blastoconidia connected by narrow tube-like connectors and catenate ch ains of various lengths characteristic of L. loboi.