title: [Unusual presentation of mycetoma caused by Actinomadurella pelletieri on the scalp].
abstract: BACKGROUND
  Mycetoma is chronic inflammatory process characterized by areas of tumefaction with draining sinus tracts. It affects the foot in 80% of cases. The purpose of this report is to describe a case that posed a diagnostic challenge due to unusual scalp location and clinical presentation.
  
  
  METHODS
  A 23-year-old woman residing in a rural zone of Senegal consulted for indolent lesions ongoing on the scalp for 2 years. Physical examination showed two soft tumid lesions measuring about 3 cm in diameter on the vertex. The surface of the lesions was crusty but showed no sign of granules. Skull x-ray was normal. Skin biopsy demonstrated a polymorphous granulomatous infiltrate with foci of suppuration circumscribing small, irregular grains with radiating filaments. Mycological culture on Lowenstein medium demonstrated Actinomadurella pelletiere. Treatment with cotrimoxazole for 8 months led to significant regression of the lesions.
  
  
  CONCLUSIONS
  The mycetoma described in this report posed a diagnostic challenge because of its unusual scalp location and especially its tumoral or pseudo-cystic presentation. This clinical form of mycetoma must be taken into account for diagnosis in any patient from endemic areas.
authors.affiliation: Service de Dermatologie, CHU, France. moussante@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Diallo
authors.forename: S O
authors.initials: SO
authors.lastname: Niang
authors.forename: T
authors.initials: T
authors.lastname: Tounkara
authors.forename: A
authors.initials: A
authors.lastname: Fricker
authors.forename: P S
authors.initials: PS
authors.lastname: Mbaye
mesh_terms: D000192:Actinomycetales / Q000302:isolation & purification*; D000193:Actinomycetales Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008271:Mycetoma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012536:Scalp Dermatoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination