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Image: A 26 year old immigrant from Nigeria, in Canada 3 years, described a painless mass slowly growing over the prior 3½ years. It was minimally uncomfortable and not tender, but would discharge intermittantly from different openings. It was firm with several mildly fluctuant areas and a small amount of pus could be discharged from a fistula . The CBC and liver enzymes were normal. What is your diagnosis? |
| case from Mike Libman MD, McGill Centre for Tropical Disease |
Image: This was a mycetoma, in fact a eumycetoma (Madura foot). A wedge biopsy revealed the histology below and one granule (pink) which on magnification (right) revealed hyphi. A fungal culture grew the fungus Pseudallescheria boydii (anamorph Scedosporium apiospermum)*. Treatment was Voriconizole and surgical debridement.
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granule (low power) |
hyphae in granule (oil emersion) |
*Other Eumycetomas producing organisms include: Pseudallescheria boydii, Leptosphaeria senegalensis, Madurella mycetomatis, Madurella grisea, Fusarium spp Acremonium flavus., Aspergillus nidulans, Neotestudina rosati, Exophiala jeanselmei, Pyrenochaeta romeroi, Curvularia spp,