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Jose Dario Martinez Villarreal, MD
Fabio Francesconi, MD
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


Lobomycosis is a chronic fungal infection of the skin and subcutaneous tissue that primarily occurs in tropical climates of Latin America. The causative organism is Lacazia loboi (formerly Loboa loboi), a dimorphic fungus found in soil, vegetation, and water. Infection occurs through traumatic implantation of the fungus into the skin.

Lobomycosis affects both humans and dolphins. The most common presentation in humans consists of slow-growing, keloid-like papules, nodules, or plaques in a localized area on exposed skin (picture 1A-C). Other manifestations of lobomycosis include ulcerated, infiltrative, verrucous, gumma-like, multifocal, and disseminated lesions.

Although lobomycosis is the accepted term for this disorder, a variety of other names have been used to refer to lobomycosis [1]. Examples include Jorge Lobo's disease, Jorge Lobo mycosis, Jorge Lobo blastomycosis, Amazonic pseudolepromatous blastomycosis, miraip or piraip ("burning" in the Tupi language), Caiabi leprosy, and lacaziosis.

The clinical features, diagnosis, and management of lobomycosis will be reviewed here.


The taxonomy of the fungus that causes lobomycosis has changed multiple times since the first description of the disease [2-7]. The general consensus is that Lacazia loboi is the preferred nomenclature [8]. L. loboi is a dimorphic fungus that may exist in a saprophytic phase in soil, vegetation, and water [9]. Molecular analyses have demonstrated a relationship between L. loboi and other fungal members of the order Onygenales, including Paracoccidioides brasiliensis [10]. Attempts to culture L. loboi in vitro have failed.

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2016.
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  1. da Lacaz CS, Porto E, Martins JE, et al. Doença de Jorge Lobo. In: Tratado de Micologia Médica Lacaz, 9th ed, Sarvier, Sao Paulo 2002. p.462.
  2. Fonseca Filho O, Arêa Leão AE. Contribuição para o conhecimento das granulomatoses blastomicoides. O agente etiológico da doença de Jorge Lobo. Rev Med Cirurg Brasil 1940; 48:147.
  3. Fonseca Filho O, Arêa Leão AE. Contribuição para o conhecimento das granulomatoses blastomicoides. O agente etiológico da doença de Jorge Lobo. Bol Acad Nac Med 1940; 112:42.
  4. Fonseca Filho O. Glenosporella loboi. In: Parasitologia Médica Parasitos e Doenças Parasitárias do Homem, Fonseca Filho O (Ed), Guanabara Koogan, Rio de Janeiro 1943. p.703.
  5. Almeida FP, da Lacaz CS. Blastomicose "tipo Jorge Lobo". An Fac Med Univ Sao Paulo 1948-1949; 24:5.
  6. Langeron M, Vanbreuseghem R. La blastomycose chéloidienne ou maladie die Jorge Lobo. In: Précis de Mycologie, 2nd ed, Langeron M, Vanbreuseghem R (Eds), Masson, Paris 1952. p.490.
  7. Borelli D. Lobomicosis: nomenclatura de su agente (revisión critica). Med Cutanea 1968; 3:151.
  8. Taborda PR, Taborda VA, McGinnis MR. Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis. J Clin Microbiol 1999; 37:2031.
  9. Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, et al. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses 2012; 55:298.
  10. Salgado CG, Tavares LS, Plautz HL, et al. Enzymatic isolation of Lacazia loboi cells from skin lesions of lobomycosis. Med Mycol 2009; 47:119.
  11. Rosa PS, Soares CT, Belone Ade F, et al. Accidental Jorge Lobo's disease in a worker dealing with Lacazia loboi infected mice: a case report. J Med Case Rep 2009; 3:67.
  12. Borelli D. Lobomicosis experimental. Dermatol Venez 1962; 3:72.
  13. Campo-Aasen I. Blastomicosis queloidiana o enfermedad de Jorge Lobo en Venezuela. Dermatol Venez 1958; 1:215.
  14. Migaki G, Valerio MG, Irvine B, Garner FM. Lobo's disease in an atlantic bottle-nosed dolphin. J Am Vet Med Assoc 1971; 159:578.
  15. Bossart GD. Suspected acquired immunodeficiency in an Atlantic bottlenosed dolphin with chronic-active hepatitis and lobomycosis. J Am Vet Med Assoc 1984; 185:1413.
  16. Rotstein DS, Burdett LG, McLellan W, et al. Lobomycosis in offshore bottlenose dolphins (Tursiops truncatus), North Carolina. Emerg Infect Dis 2009; 15:588.
  17. Paniz-Mondolfi AE, Sander-Hoffmann L. Lobomycosis in inshore and estuarine dolphins. Emerg Infect Dis 2009; 15:672.
  18. Kiszka J, Van Bressem MF, Pusineri C. Lobomycosis-like disease and other skin conditions in Indo-Pacific bottlenose dolphins Tursiops aduncus from the Indian Ocean. Dis Aquat Organ 2009; 84:151.
  19. Caldwell DK, Caldwell MC, Woodard JC, et al. Lobomycosis as a disease of the Atlantic bottle-nosed dolphin (Tursiops truncatus Montagu, 1821). Am J Trop Med Hyg 1975; 24:105.
  20. Reif JS, Schaefer AM, Bossart GD. Lobomycosis: risk of zoonotic transmission from dolphins to humans. Vector Borne Zoonotic Dis 2013; 13:689.
  21. Daura-Jorge FG, Simões-Lopes PC. Lobomycosis-like disease in wild bottlenose dolphins Tursiops truncatus of Laguna, southern Brazil: monitoring of a progressive case. Dis Aquat Organ 2011; 93:163.
  22. Van Bressem MF, Santos MC, Oshima JE. Skin diseases in Guiana dolphins (Sotalia guianensis) from the Paranaguá estuary, Brazil: a possible indicator of a compromised marine environment. Mar Environ Res 2009; 67:63.
  23. Symmers WS. A possible case of Lôbo's disease acquired in Europe from a bottle-nosed dolphin (Tursiops truncatus). Bull Soc Pathol Exot Filiales 1983; 76:777.
  24. Opromolla DV, Nogueira ME. Inoculation of Lacazia loboi into the subcutaneous tissue of the hamster cheek pouch. Rev Inst Med Trop Sao Paulo 2000; 42:119.
  25. Pecher SA, Croce J, Ferri RG. Study of humoral and cellular immunity in lobomycosis. Allergol Immunopathol (Madr) 1979; 7:439.
  26. Vilani-Moreno FR, Belone Ade F, Lara VS, et al. Detection of cytokines and nitric oxide synthase in skin lesions of Jorge Lobo's disease patients. Med Mycol 2011; 49:643.
  27. Smeltz RB, Chen J, Shevach EM. Transforming growth factor-beta1 enhances the interferon-gamma-dependent, interleukin-12-independent pathway of T helper 1 cell differentiation. Immunology 2005; 114:484.
  28. Quaresma JA, Lima LW, Fuzii HT, et al. Immunohistochemical evaluation of macrophage activity and its relationship with apoptotic cell death in the polar forms of leprosy. Microb Pathog 2010; 49:135.
  29. Pecher SA, Fuchs J. Cellular immunity in lobomycosis (keloidal blastomycosis). Allergol Immunopathol (Madr) 1988; 16:413.
  30. Xavier MB, Libonati RM, Unger D, et al. Macrophage and TGF-beta immunohistochemical expression in Jorge Lobo's disease. Hum Pathol 2008; 39:269.
  31. Ramos-E-Silva M, Aguiar-Santos-Vilela F, Cardoso-de-Brito A, Coelho-Carneiro S. Lobomycosis. Literature review and future perspectives. Actas Dermosifiliogr 2009; 100 Suppl 1:92.
  32. Borelli D. [The reservoir area of lobomycosis. Comments on the work of Dr. Carlos Peña on 2 Colombian cases]. Mycopathol Mycol Appl 1969; 37:145.
  33. Lobo J. Um caso de blastomicose, produzido por uma espécie nova, encontrada em Recife. Rev Med Pernamb 1931; 1:763.
  34. Rodríguez-Toro G. Lobomycosis. Int J Dermatol 1993; 32:324.
  35. Rodríguez-Toro G. Enfermedad de Jorge Lobo o blastomicosis queloidiana. Nuevos aspectos de la entidad en Colombia. Revisión Biomédica (Bogota) 1989; 9:133.
  36. Rodríguez-Toro G, Tellez N. Lobomycosis in Colombian Amer Indian patients. Mycopathologia 1992; 120:5.
  37. Reif JS, Peden-Adams MM, Romano TA, et al. Immune dysfunction in Atlantic bottlenose dolphins (Tursiops truncatus) with lobomycosis. Med Mycol 2009; 47:125.
  38. Bermudez L, Van Bressem MF, Reyes-Jaimes O, et al. Lobomycosis in man and lobomycosis-like disease in bottlenose dolphin, Venezuela. Emerg Infect Dis 2009; 15:1301.
  39. Paniz-Mondolfi A. Lobomycosis: An aproach after 70 years. Dermatol Venez 2003; 41:3.
  40. Paniz-Mondolfi AE, Reyes Jaimes O, Dávila Jones L. Lobomycosis in Venezuela. Int J Dermatol 2007; 46:180.
  41. Rosales T, Reyes Jaimes O, Reyes Flores O, et al. Keloidal and verrucous lesions in an Amerindian patient. Clin Exp Dermatol 2010; 35:e205.
  42. Pradinaud R. [Between Yucatan, Florida and French Guiana does lobomycosis exist in the Antilles?]. Bull Soc Pathol Exot Filiales 1984; 77:392.
  43. Pradinaud R, Grosshans E, Basset M. [A new case of Jorge Lobo disease in French Guyana]. Bull Soc Fr Dermatol Syphiligr 1969; 76:837.
  44. Pradinaud R, Joly F, Basset M, et al. [Chromomycosis and Jorge Lobo disease in French Guiana]. Bull Soc Pathol Exot Filiales 1969; 62:1054.
  45. Garzón Aldás E, Herrera Vicuña V. Lobomicosis: una serie de 5 casos. Piel 2013; 28:260.
  46. Rivas OR. Enfermedad de Jorge Lobo: primer caso diagnosticado en el Peru. Arch Peruanos Pat Clin 1972; 26:63.
  47. Talhari S, Cuba Caparo A, Ganter B. [Jorge Lobo's disease. Second Peruvian case]. Med Cutan Ibero Lat Am 1985; 13:201.
  48. Bustamante B, Seas C, Salomon M, Bravo F. Lobomycosis successfully treated with posaconazole. Am J Trop Med Hyg 2013; 88:1207.
  49. Recacoechea M, Vargas J. Experiencia con el ketoconazole en el primer caso de lobomicosis en Bolivia. Bol Inf CENETROP 1982; 8:23.
  50. HERRERA JM. [Paracoccidioides brasiliensis]. Arch Med Panamenos 1955; 4:209.
  51. Tapia A, Torres-Calcindo A, Arosemena R. Keloidal blastomycosis (Lobo's disease) in Panama. Int J Dermatol 1978; 17:572.
  52. Fonseca JJ. Lobomycosis. Int J Surg Pathol 2007; 15:62.
  53. Lacaziosis (Jorge Lobo's disease): Review and update. An Bras Dermatol 2007; 82:461.
  54. Burns RA, Roy JS, Woods C, et al. Report of the first human case of lobomycosis in the United States. J Clin Microbiol 2000; 38:1283.
  55. Elsayed S, Kuhn SM, Barber D, et al. Human case of lobomycosis. Emerg Infect Dis 2004; 10:715.
  56. Saint-Blancard P, Maccari F, Le Guyadec T, et al. [Lobomycosis: a mycosis seldom observed in metropolitan France]. Ann Pathol 2000; 20:241.
  57. Fischer M, Chrusciak Talhari A, Reinel D, Talhari S. [Sucessful treatment with clofazimine and itraconazole in a 46 year old patient after 32 years duration of disease]. Hautarzt 2002; 53:677.
  58. Papadavid E, Dalamaga M, Kapniari I, et al. Lobomycosis: A case from Southeastern Europe and review of the literature. J Dermatol Case Rep 2012; 6:65.
  59. Woods WJ, Belone Ade F, Carneiro LB, Rosa PS. Ten years experience with Jorge Lobo's disease in the state of Acre, Amazon region, Brazil. Rev Inst Med Trop Sao Paulo 2010; 52:273.
  60. Talhari S, Talhari C. Lobomycosis. Clin Dermatol 2012; 30:420.
  61. Silva D. Micose de Lobo. Rev Soc Bras Med Trop 1972; 6:85.
  62. Silva D, De Brito A. Formas clínicas não usuais de micose de Lobo. An Bras Dermatol 1994; 69:133.
  63. Machado PdA. Regressão espontânea de lesões maculosas na Blastomicose de Jorge Lobo. Acta Amazon 1972; 2:47.
  64. Vilela R, Mendoza L, Rosa PS, et al. Molecular model for studying the uncultivated fungal pathogen Lacazia loboi. J Clin Microbiol 2005; 43:3657.
  65. Azulay RD, Carneiro JA, Da Graça M, et al. Keloidal blastomycosis (Lobo's disease) with lymphatic involvement: a case report. Int J Dermatol 1976; 15:40.
  66. Opromolla DV, Belone AF, Taborda PR, Rosa PS. Lymph node involvement in Jorge Lobo's disease: report of two cases. Int J Dermatol 2003; 42:938.
  67. Miranda MF, Costa VS, Bittencourt Mde J, Brito AC. [Transepidermal elimination of parasites in Jorge Lobo's disease]. An Bras Dermatol 2010; 85:39.
  68. de Andrade LM, Azulay RD, Carneiro J. [Jorge Lobo mycosis(histopathological study)]. Hospital (Rio J) 1968; 73:1173.
  69. Vilani-Moreno FR, Belone AF, Soares CT, Opromolla DV. Immunohistochemical characterization of the cellular infiltrate in Jorge Lobo's disease. Rev Iberoam Micol 2005; 22:44.
  70. Miranda MF, Silva AJ. Vinyl adhesive tape also effective for direct microscopy diagnosis of chromomycosis, lobomycosis, and paracoccidioidomycosis. Diagn Microbiol Infect Dis 2005; 52:39.
  71. Talhari C, Chrusciak-Talhari A, de Souza JV, et al. Exfoliative cytology as a rapid diagnostic tool for lobomycosis. Mycoses 2009; 52:187.
  72. Carneiro FP, Maia LB, Moraes MA, et al. Lobomycosis: diagnosis and management of relapsed and multifocal lesions. Diagn Microbiol Infect Dis 2009; 65:62.
  73. Azulay RD, Carneiro Jde A, de Andrade LC. [Jorge Lobo blastomycosis. Etiology, experimental inoculation, immunology and pathology of the disease]. An Bras Dermatol 1970; 45:47.
  74. Lawrence DN, Ajello L. Lobomycosis in western Brazil: report of a clinical trial with ketoconazole. Am J Trop Med Hyg 1986; 35:162.
  75. Cucé LC, Wroclawski EL, Sampaio SA. Treatment of paracoccidioidomycosis, candidiasis, chromomycosis, lobomycosis, and mycetoma with ketoconazole. Int J Dermatol 1980; 19:405.
  76. Londoño F. Blastomicosis queloidiana. A propósito de un caso tratado con anfotericina B. Med Cutan Ibero Lat Am 1968; 2:521.
  77. Reyes O, Goihman M, Goldstein C. Blastomicosis queloidiana o enfermedad de Jorge Lobo. Comunicacion previa sobre un caso observado. Dermatol Venez 1960; 2:245.
  78. SILVERIE R, RAVISSE P, VILAR JP, MOULINS C. [Keloid blastomycosis or Jorge Lobo disease in French Guiana]. Bull Soc Pathol Exot Filiales 1963; 56:29.
  79. Baruzzi RG, Azevedo RA. Doença de Jorge Lobo. In: Clínica de doenças tropicais e infecciosas, Meira DA (Ed), Interlivros, Rio de Janeiro 1991. p.229.
  80. Silva D. [Treatment of Lobo's disease with clofazimine (B 663)]. Bull Soc Pathol Exot Filiales 1978; 71:409.
  81. Talhari S, Cunha MG, Barros ML, Gadelha AD. [Jorge Lobo disease. Study of 22 new cases]. Med Cutan Ibero Lat Am 1981; 9:87.
  82. Dudok van Heel WH. Successful treatment in a case of lobomycosis (Lobo's Disease) in Tursiops truncatus (Mont) at Dolfinarium, Harderwijk. Aquat Mamm 1977; 5:8.
  83. Baruzzi RG, d'Andretta C Jr, Carvalhal S, et al. [Occurrence of keloidal blastomycosis among Caiabi Indians]. Rev Inst Med Trop Sao Paulo 1967; 9:135.
  84. Nogueira L, Mendes L, Rodrigues CA, et al. Lobomycosis and squamous cell carcinoma. An Bras Dermatol 2013; 88:293.
  85. Baruzzi RG, Rodrigues DA, Michalany NS, Salomão R. Squamous-cell carcinoma and lobomycosis (Jorge Lobo's disease). Int J Dermatol 1989; 28:183.