title: Eumycetoma of the hand caused by Leptosphaeria tompkinsii and refractory to medical therapy with voriconazole.
abstract: We report on the first case of eumycetoma caused by the organism Leptosphaeria tompkinsii to be diagnosed and possibly acquired within the United Kingdom. Conventional culture of fungal grains and surgical tissue specimens was negative and the diagnosis was achieved using panfungal polymerase chain reaction and sequencing technology. Despite limited surgical resection and prolonged antifungal therapy with voriconazole, the patient developed progressive disease with mycetoma bone involvement. This case highlights the usefulness of molecular diagnostic techniques in eumycetoma where organisms may fail to grow with conventional culture or be difficult to identify morphologically. It also reminds us that eumycetoma is a difficult infection to treat and despite optimism regarding the efficacy of the newer triazole antifungals in this condition, treatment failures may still occur.
authors.affiliation: Department of Infectious Diseases, Infectious Diseases Unit, Leicester Royal Infirmary, Level 6 Windsor building, Leicester, LE1 5WW, UK.
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Cartwright
authors.forename: Tristan W
authors.initials: TW
authors.lastname: Clark
authors.forename: Abid M
authors.initials: AM
authors.lastname: Hussain
authors.forename: Martin
authors.initials: M
authors.lastname: Wiselka
authors.forename: Andrew
authors.initials: A
authors.lastname: Borman
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Johnson
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D001203:Ascomycota / Q000302:isolation & purification*; D004271:DNA, Fungal / Q000235:genetics; D003646:Debridement; D006225:Hand / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology*; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D008271:Mycetoma / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D016133:Polymerase Chain Reaction; D011743:Pyrimidines / Q000008:administration & dosage*; D017422:Sequence Analysis, DNA; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014230:Triazoles / Q000008:administration & dosage*; D006113:United Kingdom; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole