A 62-year-old fisherman from the central coast of Venezuela (Puerto Cruz and Chichiriviche de la Costa, 10°32′N, 67°14′W) was examined during a fieldwork expedition in March 2008. He had extensive lesions on the left ear and recalled that his illness began when he was ≈52 years of age and had accidentally injured the posterior portion of the helix of that ear with a fishhook. A small, solitary, hard nodule subsequently developed and was later accompanied by similar satellite lesions that tended to become confluent and form harder nodules, sometimes hyperchromic with flat and shiny surfaces (Figure 1, panel A). These nodules slowly invaded the entire free border, posterior aspect, and lobule of the ear and caused occasional pruritus and a tingling sensation. Because of the diffuse infiltration of the ear, the condition was initially diagnosed as diffuse cutaneous leishmaniasis or lepromatous leprosy.

Microscopic findings included a granulomatous reaction indicated by lymphohistiocytic elements with large numbers of multinucleated Langhan-type giant cells and numerous isolated yeast-like organisms with a birefringent membrane isolated or in chains alternating with some piriform elements showing simple gemation (Figure 1, panels B, C). The patient refused otoplasty and was treated with itraconazole; some nodules partially regressed.

On June 28, 2004, an adult male, likely inshore, bottlenose dolphin, which had recently died, was found on a beach of La Restinga National Park (11°01′N, 64°10′W) on Margarita Island, Venezuela. The dolphin was 3.8 m long and was emaciated. Several teeth were missing, especially at the distal end of the beak, and an 8-cm Conchoderma auritum stalked barnacle was attached to the right 10th mandibular tooth. The dolphin had severe lobomycosis-like disease with a large number of white, gray, and pink proliferating, congregating lesions, some bleeding, with keloidal and verrucous characteristics that formed rosettes on the beak, back, flanks, dorsal fin, tailstock, and tail (Figure 2). The dorsal fin was severely affected and the asymmetric distribution of the lesions caused the fin to bend. Granulomas extended into the oral cavity between the maxillar teeth and the palate. Unfortunately, because of a variety of factors, including a lack of field sampling capabilities, presence of crowd, and limited beach access for transport, no necropsy was conducted and no samples were available. However, the severe emaciation suggested that the dolphin had a chronic debilitating disease. Whether its poor health status favored the wide dissemination of lobomycosis-like disease or whether lobomycosis-like disease was the primary undermining factor remains unknown.