|Year : 2000 | Volume
| Issue : 6 | Page : 318-319
Alka Dogra, YC Minocha, Monisha Gupta, Sha Khurana
Source of Support: None, Conflict of Interest: None
A case of actinomycotic mycetoma presenting as multiple nodules with sinuses and swelling of left foot of six years duration is being reported. The diagnosis was confirmed histologically.
Keywords: Mycetoma, Actinomycetoma
|How to cite this article:|
Dogra A, Minocha Y C, Gupta M, Khurana S. Actinomycotic Mycetoma. Indian J Dermatol Venereol Leprol 2000;66:318-9
| Introduction|| |
Mycetoma is a disease of localized, indolent, deforming swollen lesions and sinuses involving cutaneous and subcutaneous tissues, fascia and bone. It usually occurs on the foot or hand. The disease results from the traumatic implantation of soil organisms into the tissues. The lesions are composed of suppurating abscesses and draining sinuses with the presence of grains which are characteristic of etiologic agents. The etiologic agent can be a variety of bacteria (actinomycotic mycetoma) or fungi (eumycotic mycetoma). In India, actinomycotic mycetoma is more commonly encountered than eumycotic mycetoma. However, the latter accounts for most cases reported from Northern India.
| Case Report|| |
A 25-year-old woman presented with multiple nodular lesions with swelling on the left foot of 6 years duration. The lesions were distributed mainly on the planter surface with some extension onto the dorsal surface. The initial lesion was a single nodule, which was followed by the appearance of successive nodules close together. All the nodules showed a reddish discharge. There was no history of trauma. Pain was minimal and the patient had no constitutional symptoms. [Figure - 1]
On examination, the left foot showed swelling and induration. Surface showed multiple nodules with draining sinuses and crusting. The regional lymph nodes were not enlarged. Gross examination of the discharge revealed red granules. Gram stain revealed filamentous structures. Smear for acid fast bacilli was negative. Fungal culture did not yield any growth. Biopsy showed presence of microabscesses in the subcutaneous tissue composed of neutrophils, eosinophils, plasma cells and macrophages. The centre of these collections conatined colonies of actinomycetes. X-ray of the foot was normal. After screening for renal function tests, routine hemogram, G-6- PD activity and audiometry, the patient was started on dapsone 100 mg twice a day and streptomycin 1g 1/M once a day. Wound debridement was done by the surgeons in conjunction with the medical treatment. The patient showed an excellent response in a month's time.
| Discussion|| |
Mycetoma as a medical entity was first reported as Madura foot in Madurai, India in 1842. The two categories are actinomycotic mycetoma (actinomycetoma) when the agent is an actinomycete and eumycotic mycetoma (eumycetoma) when a true fungus is involved.
The disease is characterized by formation of aggregates of the causative organisms (grains) within abscesses. The clinical features are essentially the same no matter whether fungus or actinomycete is concerned. The earliest stage is a firm, painless nodule but with time, papules, pustules which break down to form sinuses, appear on skin surface. The whole area becomes hard and swollen often without significant pain. The earliest stage is a firm, painless nodule but with time, papules, pustules which break down to form sinuses, appear on skin surface. The whole area becomes hard and swollen often without significant pain. The disease may extend to the underlying bone. The disease has been reported to respond to dapsone, cotrimoxazole, streptomycin and rifampicin. The present patient was put on dapsone and streptomycin and the patient showed a gratifying response.
| References|| |
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|4.||Palestine RF, Rogers RS. Diagnosis and treatment of mycetoma. J Am Acad Dermatol 1982;6:107-111. |
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[Figure - 1]