Shivam Goyal; Sathish Ballambat Pai; Kanthilatha Pai
Abstract
Actinomycotic mycetoma or actinomycetoma is a type of mycetoma caused by Nocardia and Actinomyces. It usually affects the trauma-prone areas or extremities of the body. It is associated with characteristic discharging granules and sinuses. Gram staining of discharged granules shows thin Gram-positive ...
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Actinomycotic mycetoma or actinomycetoma is a type of mycetoma caused by Nocardia and Actinomyces. It usually affects the trauma-prone areas or extremities of the body. It is associated with characteristic discharging granules and sinuses. Gram staining of discharged granules shows thin Gram-positive filaments. Histopathology of granules shows suppurative granulomas composed of neutrophils surrounding characteristic grains. Several antibiotics are effective, including co-trimoxazole, dapsone, streptomycin, trimethoprim (TMP), rifampicin, and amoxicillin-clavulanic acid. However, co-trimoxazole remains the gold-standard therapy. Actinomycetoma of the scalp has been rarely reported. Here, we report the case of an Asian male in his 50s presenting with swelling over the scalp. It had developed seven years ago after a road traffic accident and remained elusive to treatment. There were no discharging sinuses or granules characteristic of actinomycetoma. The Gram stain and Modified Ziehl-Neelsen stain from superficial swabs were negative for pathogens. Bacterial and fungal cultures of the biopsy sample were inconclusive. However, histopathology showed epidermis having focal acanthosis overlying granulation tissue with proliferating capillaries, edema, and infiltration by lymphocytes, plasma cells, neutrophils, and eosinophils along with scattered foreign body giant cells. Filamentous bacterial colonies with surrounding neutrophils were present. These features were suggestive of actinomycetoma. The patient was treated with oral doxycycline and co-trimoxazole and had a complete regression of swelling after three months of follow-up. This case highlights an unusual morphology and location of actinomycetoma, which should be considered when encountering subcutaneous swelling.
R Yaghoobi; N Ranjbari; S Rasaei
Volume 2, Issue 4 , 1999, , Pages 43-48
Abstract
Mycetoma is a chronic, progressive, and destructive disease primarily caused by actinomycetes. This is a report of 4 cases of actinomycotic mycetomas studied in our hospital during the last five years. The patients included 2 men, 56 and 42 years old, and 2 women, 31 and 52 years old, from Khuzestan ...
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Mycetoma is a chronic, progressive, and destructive disease primarily caused by actinomycetes. This is a report of 4 cases of actinomycotic mycetomas studied in our hospital during the last five years. The patients included 2 men, 56 and 42 years old, and 2 women, 31 and 52 years old, from Khuzestan province located in the south west of Iran. Clinically all patients presented with mycetoma syndrome (Subcutaneous swelling, sinus tracts and granules) with a duration of 3 to 20 years. The lesions were located on the foot in 3 cases and on the hand in one of them. The diagnosis was based on clinical, histopathological and mycological studies. The etiologic agents were Nocardia spp, sterptomyces spp. and actinomyces spp. and one of cultures was negative. All of them were treated with trimethoprime-sulfamethoxazole (TMP-SMZ) plus streptomycin sulfate for several months. We were able to obtain clinical cure in one case and clinical improvement in 2 cases. Early diagnosis favored an efficient therapy and the most effective therapy was combination of TMP-SMZ with streptomycin sulfate.