title: Eumycotic mycetoma caused by Madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy.
abstract: We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later. Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis. The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week. Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable. The patient appeared free of disease at 18 months of follow-up. Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.
authors.affiliation: Department of Dermatology, Hospital General de Acapulco, Acapulco, Mexico. estradaguadalupe@hotmail.com
authors.forename: Guadalupe E
authors.initials: GE
authors.lastname: Estrada-Chavez
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Vega-Memije
authors.forename: Roberto
authors.initials: R
authors.lastname: Arenas
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Chavez-Lopez
authors.forename: Roberto
authors.initials: R
authors.lastname: Estrada-Castañon
authors.forename: Ramon
authors.initials: R
authors.lastname: Fernandez
authors.forename: Roderick
authors.initials: R
authors.lastname: Hay
authors.forename: Judith
authors.initials: J
authors.lastname: Dominguez-Cherit