Available online Dec 19, 2019.
[ Report ] Volume 28, Issue 3, 2019, Pages 337-340
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
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.
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Volume 28 | Issue 3
Page Nos. 337-340
Online since Dec 17, 2019