EUMYCOTIC MYCETOMA IN A YOUNG GIRL FROM SOKOTO, NIGERIA: A RARE AND UNUSUAL PRESENTATION.

Ibitoye Paul Kehinde, Jiya Fatima Bello, Mohammed Yahaya, Mohammed Umar, Sabitu Muhammad Zainu, Adayi Susan Opkodo,Yusuf Abduganiy, Jimoh Ahmed Kolawole, Inoh Ikemesit Imeh, Oladele Rita.

Available online Dec 19, 2019.

[ Report ] Volume 28, Issue 3, 2019, Pages 337-340


Abstract

INTRODUCTION: A typical presentation of Mycetoma is not uncommon although clinical manifestations might be

 

 

 

misleading leading to delay in diagnosis, treatment and consequently leading to poor prognosis. Mycetoma can have a

 

fungal or bacterial etiology and manifestation is usually that of a disfiguring subcutaneous infection that can affect any part

 

of the exposed body. We are reporting a case of Mycetoma in an eleven years old girl that occurred in parts of the lower

 

abdomen, perineum and gluteal region that was initially thought to be a soft tissue sarcoma or disseminated tuberculosis.

CASE PRESENTATION: An eleven years old girl presented to Usmanu Danfodiyo University Teaching Hospital, Sokoto with

 

 

 

lower abdominal mass and multiple nodular masses with discharging sinuses on the upper part of the right thigh, perineum

 

and gluteal region of six months duration. Swellings started as multiple small boils that subsequently started discharging

 

from various points. Patient usually fetches firewood in the forest for her parents as her routine house chores and she

 

remembered an incident where she had pricks from thorns in the bush around her lower thigh and perineum.

 

On examination she was chronically ill looking, in painful distress, with bilateral inguinal lymphadenopathy. She had nodular

 

lesions of varying sizes ranging from 1x1cm to 4x4cm, tender, involving the upper part of the thigh bilaterally, but more on

 

the right, lower abdomen, labia and gluteal region. Some of the lesions had hyper-pigmented sinuses discharging

 

mucopurulent fluid, with areas of soft tissue swelling around the lower abdomen and upper right thigh extending to the leg.

 

Patient was observed to walk with a limp gait.

MANAGEMENT AND OUTCOME: An initial diagnosis of soft tissue infection to rule out soft tissue sarcoma and disseminated

 

 

 

tuberculosis (abdomen and lymph nodes) and deep tissue mycosis was made. However, with further investigations and

 

reviews by the medical microbiologist and anatomic pathologist, along with bacteriologic, and mycologic studies of swab

 

samples and aspirate and tissue biopsy for Histology revealed an eumycotic mycetoma. She received Ketoconazole and

 

Trimetoprim-sulphametoxazole. She responded significantly as lesions reduced in sizes, abdominal swelling and leg swelling

 

reduced with closure of discharging sinuses. Patient could walk with some resolution of the limp. Repeat abdominal

 

ultrasound scan showed resolution of initial findings. She spent four weeks in the hospital and was discharged. On

 

subsequent follow-up; she was walking without any limp and lesions were healed with some scar and few areas left to dry

 

up. Further follow-up visits after one month and three month showed progressive healing and complete resolution of lesion

 

respectively. However. Patient was however lost to further follow-up which would have enabled monitoring as to any reoccurrence

 

or not.

CONCLUSION: We presented a case of a young girl with an abnormal presentation of eumycotic mycetoma. Patient achieved

 

 

 

near cure on medications without the need of surgery due to an excellent multidisciplinary approach between pediatricians,

 

clinicians, clinical microbiologists and anatomic pathologists.

 

 


Keywords

Mycetoma, Eumycetoma, Paediatrics,

JULY - SEPTEMBER 2019

Volume 28 | Issue 3

Page Nos. 337-340

Online since Dec 17, 2019

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