Mycetoma Madura Foot – Case Report

Abstract

Madura foot or mycetoma is a chronic granulomatous disease characterized by the localized infection of subcutaneous tissues by actinomycetes or fungi. The inflammatory response can enlarge to the underlying bone. Mycetoma was characterized first in the mid-1800s and was initially known as Madura foot. The infection can be caused by true fungi (eumycetoma) in 40%, or filamentous bacteria (actinomycetoma) in 60%. Actinomycetoma may be due to Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis, and Nocardia species. The infection may persist latent for a time and it forms small, subcutaneous swellings that enlarge, soften with pus, and break through the skin surface, with concurrent invasion of deeper tissues. Sulfonamide, iodide, and anti-toxin treatment have been used against the actinomycotic contaminations, but the fungi are more resistant to the treatment. I report a patient of Madura foot from Mahatma Gandhi Medical College Hospital Research institute, Puducherry. Mrs. Indira, 40 years old female, came with the complaints of swelling over right index finger for 4 years, swelling which is initially small and progressed to grow bigger size. She had the complaints of pain over the swelling on and off for 4 years, fever, history of discharge and trauma (prick) from the swelling and lymphnode enlargement. Patient presented with restricted movements for 4 years for that she was operated under local anesthesia 3 years back. On physical examination, swelling present over right index finger, 4 cm circumference, multiple scarring, sutures, and discharges from finger also observed.
She underwent investigations like MRI which reveals that, multilobulated mass in the soft tissues surrounding the proximal and middle phalnges of the 2nd digit, no bone or tendon pathology identified this is likely to be an infectious process like actinomycetes or tuberculosis. On removed biopsy from right index finger shows that hyperkalemia and acanthotic skin with subepithelium showed chronic inflammatory granulation tissues with infiltration by lymphocytes plasma cells and occasional foreign body giant cells. There was a focus showing brownish granules, consistent with fungal morphology of Madura mycosis, stain for fungus: positive.
Patient was on treatment of T. Flucanazole OD for 5 days and she underwent amputation of right index finger. Postoperatively patient was normal.