Eumycetoma (Fungal Mycetoma) Clinical Presentation

Updated: Oct 19, 2017
  • Author: George Turiansky, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Many cases are painless, although painful lesions may prompt the individual to seek medical attention. Gradual enlargement of the affected site and difficulties with ambulation may also prompt affected persons to seek care. Predisposing factors include the following:

  • History of trauma

  • Walking barefoot

  • Agricultural work

  • Poor personal hygiene

  • Poor nutrition

  • Wounds or multiple infections

Next:

Physical Examination

The foot is the most common site of infection; 70% of all mycetomas affect the foot. Other reported sites of involvement include the following:

  • Upper extremities

  • Trunk

  • Buttocks

  • Eyelids

  • Lacrimal glands

  • Paranasal sinuses

  • Mandible

  • Scalp

  • Neck

  • Perineum

  • Testes

The disease is initially limited to the skin and subcutaneous tissue but may eventually spread through the fascial planes to contiguous structures, as follows:

  • Muscle

  • Bone

  • Blood and lymphatic vessels

  • Nerves

Rarely, the disease may spread to the regional lymph nodes or viscera.

Eumycetoma is characterized by the clinical triad of tumefaction, draining sinuses, and granules (see images below).

Eumycetoma of the leg with tumefaction, deformity, Eumycetoma of the leg with tumefaction, deformity, and multiple sinus tracts in a patient from Costa Rica. Courtesy of Mervyn L. Elgart, MD, Washington, DC.
Eumycetoma of the foot with tumefaction, deformity Eumycetoma of the foot with tumefaction, deformity, and multiple sinus tracts. Courtesy of Mervyn L. Elgart, MD, Washington, DC.

The disease usually begins as a painless swelling or thickening of the skin and subcutaneous tissue. As the disease gradually progresses over months or years, the initial lesion enlarges and eventually becomes tumorous. The overlying skin may be smooth, dyspigmented, or shiny.

Abscesses and sinus tracts develop over time and may contain a serosanguineous or seropurulent discharge, which may contain white-to-yellow or black granules. Granules are firm 0.2- to 5-mm aggregates of organized vegetative, septate hyphae, which often are embedded in a matrix cement substance. These granules are usually macroscopic and are observed in the lesional tissue and in sinus tracts. The color of the dark grains is thought to be due to melanin, host protein, and dark debris. Regional lymphadenitis secondary to bacterial superinfection of the lesion may be present.

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