Eumycetoma infection of the hand: A case report

Abstract

Mycetoma is a chronic granulomatous infection of cutaneous and subcutaneous tissues caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). The most common site of infection is the foot, followed by the hand, but sometimes other body parts may also be infected. The patients present with a painless hard and swelling subcutaneous mass, multiple sinuses, and the pathognomonic discharge of grains. A 42-year-old male patient, presented pain and swelling in his right hand and also complained of swelling in his right forearm. The swelling later involved his whole right hand and wrist joint. Physical examination revealed multiple discharging sinuses with serosanguineous exudates and black grains. Swelling and local erythema were present, lymph nodes were not palpable. The patient complained of constant mild pain which is relieved by pain medications. The serohematic discharge was witnessed with conglomerates of small and firm blackish pellets, evoking eumycetomaSaline dressing was applied overnight and next morning grains were directly collected from sinuses. Tissue and black grain samples were analyzed for bacterial and mycological evaluation. Direct microscopy was performed using Gram stain showed thicker hyphae of eumycetoma. Modified ZN stain showed no acid fast bacilli. LPCB was helpful in confirming thicker hyphae of eumycetoma. Here, on clinical diagnosis (classical triad that is, painless soft tissue swelling, draining sinuses and extrusion of grains) with microbiological investigation, we concluded it a case of “Eumycetoma”.