IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 4035 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
    Introduction
    Case Report
    Discussion
    References

 Article Access Statistics
    Viewed7137    
    Printed61    
    Emailed3    
    PDF Downloaded4    
    Comments [Add]    

Recommend this journal

 
CASE REPORT
Year : 2002  |  Volume : 68  |  Issue : 3  |  Page : 174-175

Eumycotic mycetoma in the leg with a bone cyst in fibula


Department of Dermatology, Rajah Muthaih Medical College & Hospital Annamalai University, Annamalai Nagar- 608 002, India

Correspondence Address:
Department of Dermatology, Rajah Muthaih Medical College & Hospital Annamalai University, Annamalai Nagar- 608 002, India



How to cite this article:
Prasad P V, George RV, Paul EK, Ambujam S, Sethurajan S, Krishanasamy B, Rao L L. Eumycotic mycetoma in the leg with a bone cyst in fibula. Indian J Dermatol Venereol Leprol 2002;68:174-5


How to cite this URL:
Prasad P V, George RV, Paul EK, Ambujam S, Sethurajan S, Krishanasamy B, Rao L L. Eumycotic mycetoma in the leg with a bone cyst in fibula. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2020 May 29];68:174-5. Available from: http://www.ijdvl.com/text.asp?2002/68/3/174/12560



   Introduction Top

Mycetoma is a chronic disease of the skin, subctaneous tissue and bones characteristically affecting the foot. It can also affect other parts of the body.[1] The infection is caused by either a bacterium that is actinomycetes or by higher fungi (eumycetoma agent).
In India mycetoma is commonly caused by the species Madurella mycetomatis.[2] The disease was first recognised by Dr. Gill in 1842 from South India.[3] It is largely confined to tropical and subtropical areas. It is mainly seen in Africa, India, Mexico and parts of South America.[4] The disease presents first as painless papules and nodules and then progresses to form pustules which break down to form sinuses and open onto the skin surface discharging purulent or seropurulent materials with various colours of granules like yellow, black, red or white. It may progress to erode the cortex of the bone and produce cystic defects in the medulla.[2] Treatment with antifungals is not encouraging and beneficial only in some patients of eumycotic mycefoma. Wide excision has been tried in some, failing which amputation remains the only effective treatment.[1]

   Case Report Top

A 61 - year-old man, a farmer presented with a history of swelling of the right leg of 8 years duration with multiple discharging sinuses. He had a history of thorn prick one year prior to the onset of the lesion. On examination a large swelling measuring 14 x 10 cm in size extending from the right knee joint to the shin was seen [Figure - 1]. It was firm in consistency. Multiple sinuses were seen with some of them discharging black granules. KOH examination from the granules revealed hyphae. Histopathological examination of the lesion was consistent with eumycatic mycetoma. Radiological examination of the right leg revealed osteolytic lesion in the fibula with a bone cyst [Figure - 2]. The patient was treated with fluconazole 150 mg per week and is under observation.

   Discussion Top

The major criteria for clinical diagnosis of mycetoma are (1) swelling (2) sinuses and (3) granules. It shows typical clinical features which makes the diagnosis easier. The site commonly involved is the foot but involvement of other sites are also recorded. Black granules are characteristic of eumycotic mycetoma. Our patient showed the characteristic lesion with black granules. The diagnosis in our patient was supported by KOH examination and confirmed by histopathological examination. From the granules Madurella mycetomatis was isolated in the culture.
Bone involvement is known to occur in eumycotic mycetoma. The changes comprise of cyst - like cavities in the metatarsal bones and bone sclerosis.[4] These changes are recorded mainly in the foot. Our patient had a bone cyst with osteolytic lesion in the fibula. The changes in the long bones in association with mycetoma is an unknown entity.
As surgery could not be contemplated in our patient he was treated with oral fluconazole. The actual response could not be assessed as the patient was lost to follow up. 

   References Top

1.Hay RJ, Moore M. Mycology. In: Champion RH, Burton JL, Bums DA and Breathnach SM, eds. Textbook of Dermatology. Vol 2. 6th edn. Oxford: Blackwell Science 1998:1354-1356.  Back to cited text no. 1    
2.Renton Peter. Periosteal reaction in bone and joint infection. In: Sutton David. Textbook of Radiology and Medical Imaging. Vol I. 5th edn. New York USA: Churchill Livingston 1992:67-68.  Back to cited text no. 2    
3.Daniel W. Infections and related disorders of bone. In: Daniel W. Radiology of bone tumours and allied disorders. Vol 4. 1st edn. Philadelphia USA: WB Sounders Company 1982: 3593 - 3595.  Back to cited text no. 3    
4.Ronald OM, Harold GJ. Mycetoma. In: Ronald OM, Harold GJ and Dennis JS eds. The Radiology of Skeletal Disorders. 3rd edn. New York USA: Churchill Livingstone 1989:352-353.  Back to cited text no. 4    

 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow