Indexed with PubMed and Science Citation Index (E) 
Users online: 3207 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
   Next article
   Previous article 
   Table of Contents
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   Article in PDF (126 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

  In this article
   Case Report
   Article Figures

 Article Access Statistics
    PDF Downloaded186    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


Year : 2006  |  Volume : 72  |  Issue : 2  |  Page : 143-144

Mycetoma sans sinuses

1 Departments of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
2 Departments of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Correspondence Address:
Anita Dhar
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110 029
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0378-6323.25642

Rights and Permissions


Mycetoma is a chronic suppurative infection involving the skin, subcutaneous tissue and bone. The hallmark of mycetoma is tumefaction, draining sinuses and the presence of microcolonies called grains. Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion. The following case is reported as no sinuses had developed despite the presence of the lesion for 9 years, posing a diagnostic dilemma.

Keywords: Chlaymodspores, Mycetoma, Suppurative granuloma

How to cite this article:
Saha S, Dhar A, Karak A K. Mycetoma sans sinuses. Indian J Dermatol Venereol Leprol 2006;72:143-4

How to cite this URL:
Saha S, Dhar A, Karak A K. Mycetoma sans sinuses. Indian J Dermatol Venereol Leprol [serial online] 2006 [cited 2020 May 31];72:143-4. Available from: http://www.ijdvl.com/text.asp?2006/72/2/143/25642

  Introduction Top

Mycetoma is a disease with a characteristic sign of discharging sinuses.[1] Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion.[2] We report a case of mycetoma without such sinuses. The diagnosis was established after surgical removal of the lesion.

  Case Report Top

A 50-year-old man presented with a lesion on the right great toe since 9 years. There were no associated symptoms and the lesion was not increasing in size. There was no history of preceding trauma. On examination, there was a 2 x 2 cm (length x breadth) firm, nontender soft tissue swelling over the base of the right great toe with irregular edges [Figure - 1]. There were no clinical signs of inflammation, ulceration, discharge or sinuses. The swelling was free from the underlying bone and tendons.

An X-ray revealed no bony involvement. Wedge biopsy from the lesion showed chronic perivascular inflammatory cell infiltration in the dermis. The lesion was excised with primary closure of the defect. Histopathology of the specimen revealed features of mycetoma caused by a true fungus; both fungal hyphae and chlamydospores were present. On H and E staining, numerous sulfur granules were found lying amidst a neutrophilic abscess. Further, numerous fungal hyphae were detected on methenamine staining [Figure - 2].

  Discussion Top

Mycetoma is a chronic infectious disease usually involving an extremity. The causal agents generally enter the skin as a result of trauma. The incubation period varies from weeks to several years. Following implantation of the organism, a painless nodule slowly develops and gradually increases in size. The infection typically waxes and wanes from weeks to several years, with the development of recurrent ulceration and multiple draining sinuses and the presence of granules in the discharge. Sinuses seldom develop before 3 months; but about one-third of patients have discharging sinuses by 3 to 6 months and nearly all patients have sinuses by the end of one year.[2] Eventually the infection spreads along the facial planes, extending to deeper structures, leading to bone and joint destruction.

The causal agents producing the clinical syndrome can be divided into two classes: actinomycetes and true fungi (eumycetoma). Identification of the cause of mycetoma is based on microscopic examination of granules and isolation of the organisms by culture.[1] Special stains such as PAS and Gomori's methenamine silver will show hyphae and other fungal structures within the grains.[1]

The treatment of mycetoma is difficult. Generally actinomycotic mycetoma responds more favorably to treatment than mycetoma caused by a true fungus.[2] If diagnosed sufficiently early, complete excision of a small circumscribed lesion may result in complete cure. Larger lesions require surgical debridement of necrotic and grossly infected tissue plus long-term systemic therapy with ketoconazole or itraconazole.[2] Amputation should be considered as a final measure in large lesions that do not respond to conservative surgical intervention and medical treatment.[1]

In our patient, there were no sinuses or granules to suggest that the lesion was mycetoma. This was an unusual presentation of mycetoma. Hay et al. had also reported patients who had longstanding mycetomas without sinuses.[3]

We conclude that in endemic areas, mycetoma should be considered in the differential diagnosis of chronic subcutaneous lesions, even if there are no sinuses or discharging grains, as surgical excision of such lesions may result in complete cure.

  References Top

1.Zaias N, Taplin D, Gerbert. Mycetoma. Arch Dermatol 1969;99:215-25.   Back to cited text no. 1    
2.McGinnis. Mycetoma. Dermatology Clin 1996;41:97-104.  Back to cited text no. 2    
3.Hay RJ, Mackenzie DW. Mycetoma in UK: A survey of forty-four cases. Clin Exp Dermatol 1983;8:553-62.  Back to cited text no. 3    


[Figure - 1], [Figure - 2]

This article has been cited by
1 Mycetomatoid infection of the penis by Candida albicans
Antonio Mastrolorenzo,Barbara Giomi,Emanuele Maria Cipollini,Rosario Tammaro,Nicola Decarli,Daniele Cammelli,Francesca Fabiani Tropeano,Luana Tiradritti,Elisa Margherita Difonzo,Giuliano Zuccati
International Journal of Dermatology. 2012; 51(9): 1082
[Pubmed] | [DOI]
2 Cerebral nocardia masquerading as metastatic CNS disease in an endometrial cancer patient
Rettenmaier, N.B., Epstein, H.D., Oi, S., Robinson, P.A., Goldstein, B.H.
European Journal of Gynaecological Oncology. 2009; 30(1): 90-92


Print this article  Email this article
Previous article Next article


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