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| CLINICAL IMAGE |
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| Year : 2022 | Volume
: 19
| Issue : 3 | Page : 190-191 |
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Actinomycetoma of foot caused by Nocardia - A case report
Praveen Kasina1, Sowmya Srirama1, Eshwar Rajesh2, Venkata Ramana Kandi3, Tarun Kumar Suvvari4
1 Department of DVL (Dermatology, Venerology & Leprosy), Siddhartha Medical College, Kakinada, India
2 Madras Medical College, Chennai, Tamil Nadu, India
3 Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India
4 Rangaraya Medical College, Kakinada, India
| Date of Submission | 21-Feb-2022 |
| Date of Decision | 01-Jun-2022 |
| Date of Acceptance | 03-Jun-2022 |
| Date of Web Publication | 11-Jul-2022 |
Correspondence Address:
Tarun Kumar Suvvari
Rangaraya Medical College, Kakinada
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_31_22
How to cite this article:
Kasina P, Srirama S, Rajesh E, Kandi VR, Suvvari TK. Actinomycetoma of foot caused by Nocardia - A case report. Apollo Med 2022;19:190-1 |
Mycetoma is a chronic, suppurative, granulomatous disease of the subcutaneous tissues and bones.[1] Mycetoma can be eumycetoma (due to fungi) or actinomycetoma (due to bacteria).[2]
A 36-year-old male, farmer by occupation, presented with swelling of the left foot for 4 years. He was a known case of type-2 diabetes mellitus on oral medication. Over the past 4 years, swelling progressed with multiple draining sinuses. Pain was not associated with the swelling.
On examination, a massive hyperpigmented swelling with multiple sinuses extending from the lower third of left leg to the dorsum of the foot [Figure 1]. The discharge was yellowish-white in color and blood tinged with yellowish-white grains observed after 24 h of occlusive dressing. | Figure 1: Massive swelling and multiple sinuses along with yellowish-white discharge involving lower region and foot of left leg
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Histopathological examination revealed hyperplastic stratified squamous epithelium with underlying tissue showing mild inflammatory infiltrate and hemorrhage [Figure 2]. No fungal elements were seen. Microbiological staining revealed Gram-positive, periodic acid–Schiff-negative and acid-fast-positive organisms [Figure 3]. The sample cultured on Sabouraud dextrose agar yielded no growth. X-ray of the left foot showed osteolysis of tarsals and metatarsals. Computed tomography scan revealed soft tissue edema with thickening in the distal leg region along with foot chronic infective inflammatory pathology. | Figure 2: Hyperplastic stratified squamous epithelium with underlying tissue showing mild inflammatory infiltrate and hemorrhage (×4)
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 | Figure 3: Pink-colored long filamentous branching bacilli as observed on modified acid fast staining (×100)
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The patient was clinically diagnosed as a case of mycetoma based on clinical triad, and based on microbiological investigations, a final diagnosis of actinomycetoma due to Nocardia. He was admitted in the Dermatology, Venereology, and Leprosy Ward and started on antibiotic therapy. Exploration, drainage of sinus tracts, and debridement of diseased tissue were done along with the initiation of parenteral antibiotics.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Funding
Nil.
Author Contributions
Conceptualized the idea and designed the manuscript – Praveen and Tarun overall manuscript supervision – Soumya and Ramana drafting of manuscript - Praveen, Tarun and Eshwar Editing and reviewing of the manuscript - Soumya, Ramana and Tarun. Additional changes to manuscript - Tarun and Eshwar All authors revised and approved the final draft.
| References | |  |
| 1. | Zijlstra EE, van de Sande WW, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: A unique neglected tropical disease. Lancet Infect Dis 2016;16:100-12.  |
| 2. | Verma P, Jha A. Mycetoma: Reviewing a neglected disease. Clin Exp Dermatol 2019;44:123-9. |
[Figure 1], [Figure 2], [Figure 3]
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