{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:20:15Z","timestamp":1791958815540,"version":"4.3.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Chromoblastomycosis (CBM) is a difficult-to-treat, chronic fungal infection of the skin and subcutaneous tissue. The evidence base for treatment is scarce, with no standardized therapeutic approach. Chronicity of CBM infection is postulated to be due in part to a failure of host cell\u2013mediated immunity to generate a proinflammatory response sufficient for fungal clearance. We present a case of a chronic chromoblastomycosis lesion of the hand present for nearly 4 decades, previously refractory to itraconazole monotherapy, that was successfully treated with a combination of posaconazole and adjunctive immunotherapy with topical imiquimod, a Toll-like receptor 7 agonist. Serial biopsies and images demonstrate the clinical and histopathological improvement of the lesion. Randomized trials of antifungal therapy with adjunctive imiquimod are warranted to determine whether a combination of antifungal and host-directed therapy improves outcomes for this neglected tropical mycosis.<\/jats:p>","DOI":"10.1093\/ofid\/ofad124","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T13:56:09Z","timestamp":1678802169000},"source":"Crossref","is-referenced-by-count":14,"title":["Chromoblastomycosis Treated With Posaconazole and Adjunctive Imiquimod: Lending Innate Immunity a Helping Hand"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3037-8314","authenticated-orcid":false,"given":"Clare","family":"Logan","sequence":"first","affiliation":[{"name":"Clinical Infection Unit, St George\u2019s University Hospitals NHS Foundation Trust , London , United Kingdom"},{"name":"Institute of Infection & Immunity, St Georges University London , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuraj","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Cellular Pathology, St George\u2019s University Hospitals NHS Foundation Trust , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalya","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Dermatology, St George\u2019s University Hospitals NHS Foundation Trust , London , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Brown","sequence":"additional","affiliation":[{"name":"MRC Centre for Medical Mycology, University of Exeter , Exeter , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreedhar","family":"Krishna","sequence":"additional","affiliation":[{"name":"Department of Dermatology, St George\u2019s University Hospitals NHS Foundation Trust , London , United 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University London , London , United Kingdom"},{"name":"MRC Centre for Medical Mycology, University of Exeter , Exeter , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,14]]},"reference":[{"key":"2023040611344586400_","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1128\/CMR.00032-16","article-title":"Chromoblastomycosis","volume":"30","author":"Queiroz-Telles","year":"2017","journal-title":"Clin Microbiol Rev"},{"key":"2023040611344586400_","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1590\/abd1806-4841.20187321","article-title":"Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update","volume":"93","author":"de Brito","year":"2018","journal-title":"An Bras Dermatol"},{"key":"2023040611344586400_","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009611","article-title":"The global burden of 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