Eumycetoma of the Foot in a 70-Year-Old Male Farmer
Funding: The authors received no specific funding for this work.
ABSTRACT
Clinicians should consider eumycetoma, actinomycotic mycetoma, and skin cancers in patients from tropical or subtropical regions who present with painless swelling and discharging sinuses. The early histopathology, microbiological studies in conjunction with imaging, are of critical importance in narrowing the differential and starting appropriate treatment to prevent complications and deformities.
1 Case Presentation
A 70-year-old male patient of Pakistani origin, farmer by profession, presented to the emergency department with complaints of painless swelling and pus discharge containing grains from the right foot. The patient was nondiabetic and had no family history of such infections. On examination, multiple discharging sinuses were seen on both the dorsal and plantar surfaces of the right foot (Figure 1). The patient had normal vitals, including blood pressure and temperature.
CT scan foot and MRI scan foot were recommended, but due to financial constraints, the patient was unable to afford these tests.
A wedge biopsy of the wound on the foot was taken that grossly was ulcerated, a single skin-covered tissue fragment measuring 3 × 1.4 cm. On microscopic evaluation, features diagnostic of eumycetoma (Madura foot) were seen (Figure 2). No malignancy was seen.
Patient was treated with itraconazole 100 mg twice-daily. On follow-up of 3 months, moderate improvement was seen in wounds and swelling. However, the pus discharge had stopped. Surgical excision was done for residual lesions, which then healed properly on further follow-ups. Written informed consent was obtained from the patient for publication of this case and associated images.
2 Discussion
Mycetoma is a slowly evolving chronic granulomatous disease that involves the skin and the adjacent subcutaneous tissue [1]. Eumycetoma is, therefore, a dermal and subcutaneous mycosis caused by filamentous fungi [2]. Currently, mycetoma has been included in the list of neglected tropical diseases whose impact is huge and which affect the inhabitants of tropical and subtropical countries that experience direct contact with the ground [3]. Patients with painless swelling, discharging sinuses, and tropical or subtropical climates should be taken into consideration within the differential diagnosis of eumycetoma, actinomycetoma, and some skin cancers, including squamous cell carcinoma. The most important investigations involve histopathological analysis or microbiological cultures, in combination with imaging studies, whenever possible, to confirm the diagnosis and exclude other possibilities.
Author Contributions
Allahdad Khan: conceptualization, data curation, investigation, methodology, project administration, supervision, writing – original draft, writing – review and editing. Saad Masood: conceptualization, data curation, investigation, writing – review and editing. Aseel Kamal: conceptualization, methodology, writing – review and editing.
Consent
Written consent from the patient was obtained.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
Data available on request from the authors.
