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Eumycetoma (Fungal Mycetoma): Differential Diagnoses & Workup

Author: George Turiansky, MD, Associate Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Director, National Capital Consortium Dermatology Residency Program, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Jan 15, 2009

Differential Diagnoses

Cutaneous Tuberculosis
Sporotrichosis
Squamous Cell Carcinoma
Syphilis
Verrucous Carcinoma
Yaws

Other Problems to Be Considered

Actinomycetoma
Botryomycosis
Chromoblastomycosis
Sporotrichosis
Tuberculosis
Blastomycosis
Coccidioidomycosis
Elephantiasis
Osteomyelitis
Malignancy
Yaws (eg, frambesia tropica)

Workup

Laboratory Studies

  • Identification of the etiologic agent of eumycetoma is based on direct microscopic examination of the granules, culture isolation of the agent, colonial features and fungal microscopic morphology.6
  • Eumycetoma granules can be crushed and examined at microscopy with direct wet mounts after treatment with 10-20% potassium hydroxide, lactophenol cotton blue, Albert stain, or physiologic saline solution.
  • Eumycetoma agents appear as broad, septate, branching hyphae 2-5 µm in diameter or, as in the case of E jeanselmei, as a compact mass of rounded cells.
  • Fresh granules can be teased from lesional tissue or biopsy specimens. These cells can be washed in saline solution or saline solution containing antibiotics prior to culturing on fungal media such as Sabouraud dextrose agar, blood agar, or a brain-heart infusion containing antibiotics.
  • Granules from draining sinus tracts may not be optimal for culturing because of bacterial contamination.
  • Recently, Ahmed et al reported 2 cases of leg eumycetoma due to M mycetomatis that were successfully identified by species-specific polymerase chain reaction and DNA sequencing.
  • Fine-needle aspiration cytology of lesional tissue with the use of special stains may be useful in diagnosis.7

Imaging Studies

  • Radiographs, CT scans, and MRIs demonstrate the presence and extent of bone or organ involvement.
  • Changes of underlying bony structures may include the following:
    • Osteoporosis
    • Bony destruction
    • Loss of cortical margin with bony erosion
    • Punched-out lytic lesions
    • Osteophyte formation
    • Osteomyelitis
    • Periosteal elevation
    • Marrow infiltration
    • Coarse trabecular pattern
    • Bony expansion

Histologic Findings

A biopsy specimen should be obtained from a small abscess or from the sinus tract. Hematoxylin-eosin stained sections reveal extensive granulation tissue containing abscesses. Granules of 0.2-5.0 mm in diameter may be found in abscesses or sinuses. Eumycotic granules have positive results with periodic acid–Schiff and Gomori methenamine silver stains. They contain gram-negative septate hyphae that are 2-5 µm in diameter. Eosinophilic material may be seen deposited around the granule; this material represents an immunologic response, the Splendore-Hoeppli reaction.

More on Eumycetoma (Fungal Mycetoma)

Overview: Eumycetoma (Fungal Mycetoma)
Differential Diagnoses & Workup: Eumycetoma (Fungal Mycetoma)
Treatment & Medication: Eumycetoma (Fungal Mycetoma)
Follow-up: Eumycetoma (Fungal Mycetoma)
Multimedia: Eumycetoma (Fungal Mycetoma)
References
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References

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  2. Carter HV. On mycetoma or the fungus disease of India. London, England: J & A Churchill; 1874.

  3. Green WO Jr, Adams TE. Mycetoma in the United States; a review and report of seven additional cases. Am J Clin Pathol. Jul 1964;42:75-91. [Medline].

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  5. Turiansky GW, Benson PM, Sperling LC, Sau P, Salkin IF, McGinnis MR, et al. Phialophora verrucosa: a new cause of mycetoma. J Am Acad Dermatol. Feb 1995;32(2 Pt 2):311-5. [Medline].

  6. Ahmed AO, Desplaces N, Leonard P, Goldstein F, De Hoog S, Verbrugh H, et al. Molecular detection and identification of agents of eumycetoma: detailed report of two cases. J Clin Microbiol. Dec 2003;41(12):5813-6. [Medline].

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  17. Mahgoub ES, Murray IG. Mycetoma. London, England: William Heinemann Medical Books; 1973:1-5, 47-53.

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Further Reading

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Keywords

eumycetoma, Madura foot, maduromycosis, fungal mycetoma, eumycotic mycetoma, melanoid mycetoma, ochroid mycetoma

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Contributor Information and Disclosures

Author

George Turiansky, MD, Associate Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Director, National Capital Consortium Dermatology Residency Program, Walter Reed Army Medical Center
George Turiansky, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Association of Professors of Dermatology, and Ukrainian Medical Association of North America
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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