We report a case of eumycetoma in a Filipino patient who presented with a solitary reddish brown, moist, multinodular tumor on the dorsum of the left foot of 2 years duration. Biopsy with Periodic acid Schiff (PAS) & Gomori methenamine silver (GMS) staining, fungal culture, ultrasound and X-ray of the foot were done in our institution which confirmed the diagnosis of eumycetoma. The patient was successfully treated with itraconazole 400/day for 3 months, followed by 200mg/day for the succeeding 9 months, leading to complete resolution of the lesion leaving an atrophic hypopigmented scar. A high index of suspicion supported by diagnostic tests aided in the early detection of the disease which also resulted to complete resolution of the disease.
Mycetoma ; Mycoses ; Itraconazole

When a soft tissue mass in the bony wall of the paranasal sinus is present, it is difficult to make a distinction between tumor and inflammatory mass on CT. Fungal sinusitis may have soft tissue attenuation on the bony wall of the sinus, bony sclerosis, focal bony destruction, and calcific area on CT. This is a report of four proven cases of fungal sinusitis, asperogillosis in 3 cases and mucormycosis in 1 case, All 4 patients had CT and one patient had MRI, On CT, bony sclerosis and destruction were well visualized in all cases. On MRI, mycetoma in the maxillary sinus was hypointense on T1 weighted images and more hypointense on T2 weighted images. Although CT appears to be the best modality for initial examination of the patient with sinusitis, the differentiation of fungal sinusitis from tumor mass or other entity may be better accomplished with MRI.
Humans ; Magnetic Resonance Imaging ; Maxillary Sinus ; Mucormycosis ; Mycetoma ; Sclerosis ; Sinusitis

Botryomycosis is a rare pyogenic disease that presents with chronic suppurative and granulomatous skin lesions, commonly caused by Staphylococcus aureus. We report a case of botryomycosis presenting similarly to mycetoma, secondary to the emerging cutaneous pathogen Staphylococcus simulans. A 46-year-old female who previously worked in a wet market presented with a 13-year history of suppurative papules on a gradually enlarging right foot, and pain on ambulation. She had no systemic symptoms or co-morbidities, and does not recall preceding trauma. Physical examination showed brawny edema of the right foot with multiple sinus tracts draining purulent discharge. The clinical diagnosis at presentation was mycetoma. Magnetic resonance imaging showed a soft tissue mass involving the right foot and ankle with osseous destruction. Biopsy revealed suppurative granulomatous dermatitis; staining with Grocott methenamine silver did not highlight fungal elements. Potassium hydroxide mount of the purulent discharge did not show grains or hyphal elements. Tissue cultures showed growth of co-trimoxazole-susceptible Staphylococcus simulans. The patient was managed as a case of botryomycosis and treated with co-trimoxazole for 12 months. There was a significant decrease in right foot circumference along with scarring and resolution of associated pain. Repeat biopsy showed no evidence of infection. This is the first reported case of botryomycosis in the Philippines as well as the first report citing Staphyloccocus simulans as a causative agent. Botryomycosis is an important differential in patients clinically presenting as mycetoma. Animal pathogens may need to be considered as etiologic agents in at-risk patients with chronic subcutaneous infections.

A 14-year-old boy and his 16-year-old elder brother, who had generalized tinea corporis for 1 and 3 years respectively, developed multiple discrete, non tender soft tumors on the scalp, forehead, neck and extremities. The boys were well nourished and had no systemic diseases. Histopathologic examination of the subcutaneous nodules revealed a well encapsulated granuloma containing lobulated granules characteristic of mycetoma; these granules consisted of septated fungal hyphae with vesicles. The dermatophyte isolated from the tumors was identified as Trichophyton schoenleinii.
Adolescent ; Arthrodermataceae ; Extremities ; Forehead ; Granuloma ; Humans ; Hyphae ; Male ; Mycetoma ; Neck ; Scalp ; Siblings* ; Tinea ; Trichophyton*

BACKGROUND: There are three kinds of diseases caused by dematiaceous fungi: chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma. The dematiaceous fungi have been identified and classified by morphological, biochemical and physiological tests. Recently molecular analysis has been introduced to the field of medical mycology. OBJECTIVE: We investigated the genetic diversity of dematiaceous fungi using random amplified polymorphic DNA (RAPD). METHODS: The dematiaceous fungal strains studied were eight clinical isolates of chromoblastomycosis and phaeohyphomycosis agents (3 strains of Fonsecaea pedrosoi, 2 strains of Exophiala dermatitidis, 1 strain of Exophiala jeanselmei, 1 strain of Phialophora verrucosa, 1 strain of Rhinocladiella aquaspersa) and 4 standard strains (F. pedrosoi IFM 4889, E. dermatitidis IFM 4828, P. verrucosa IFM 4928, R. aquaspersa IFM 4930). Total twelve strains of dematiaceous fungi were cultured on Sabouraud's dextrose broth and their DNA were extracted by bead-beating method. RESULTS: The optimal condition for PCR was template DNA 0.025 mg and annealing temperature 39 degrees C. The RAPD analysis using OPA 10 primer (5'-GTGATCGCAG-3') of Operon kit showed different patterns among dematiaceous fungi. But one clinical isolate of F. pedrosoi showed intra-specific variability. CONCLUSION: The RAPD analysis is considered a rapid and reliable method for identification and classification of dematiaceous fungi if the procedure is carefully standardized with adequate primer.
Chromoblastomycosis ; Classification ; DNA* ; Exophiala ; Fungi* ; Genetic Variation* ; Glucose ; Mycetoma ; Mycology ; Operon ; Phaeohyphomycosis ; Phialophora ; Polymerase Chain Reaction

Acute cavitating pulmonary infection with a mycetoma is sometimes occur in immunocompromised patient. Most mycetoma lesions are due to Aspergillus species, and lesion caused by Candida species is rare. So we report an experienced case that pulmonary and rib infection caused by Candida species-'in -AML patient and complete remission with previous reports.
Aspergillus ; Candida albicans* ; Candida* ; Candidiasis ; Humans ; Immunocompromised Host ; Lung Diseases, Fungal ; Mycetoma* ; Ribs

Allergic fungal sinusitis (AFS) is a benign, noninvasive form of fungal sinusitis. Histologically, AFS is characterized by allergic mucin, which consists of eosinophilic mucinous material with occasional laminar deposits of eosinophils. A diagnosis of AFS can be made when there is a demonstration of characteristic allergic mucin and an appearance of fungal hypae scattered within the mucin with no evidence of tissue invasion, or when fungi cultures yield positive results. Until now, no cases of AFS have been reported in Korea, though there have been many cases of mycetomas and a few cases of invasive fungal sinusitis. We present the first two cases of AFS in Korea. The patients demonstrated characteristic allergic mucin, fungal hypae scattered within the mucin, and no evidence of tissue invasion on histopathology. Nasal polyps, involvement of the unilateral sinuses, peripheral eosinophilia, an elevated total IgE, and hyperattenuated masses observed in the CT supported the diagnosis of AFS. The patients recovered and did not display recurrence after surgery and treatment with topical steroids and saline irrigation.
Diagnosis ; Eosinophilia ; Eosinophils ; Fungi ; Humans ; Immunoglobulin E ; Korea ; Mucins ; Mycetoma ; Nasal Polyps ; Recurrence ; Sinusitis* ; Steroids

Scedosporium(S) apiospermum is the asexual stage of Pseudallescheria boydii. The organism has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. This ubiquitous fungus causes not only mycetoma, but also infections of variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. Infection may occur via direct inoculation and usually affects the extremities. We report a case of localized cutaneous infection due to S. apiospermum which occurred in a 79-year old female. She presented multiple erythematous papulopustules on the right wrist. Culture isolation for definitive diagnosis showed S. apiospermum. The patient was treated successfully with oral itraconazole 200 mg daily for 4 weeks.
Edible Grain ; Extremities ; Female ; Fungi ; Humans ; Itraconazole ; Mycetoma ; Pseudallescheria ; Scedosporium ; Sewage ; Skin ; Soil ; Wrist

The dematiaceous fungi, characterized by having melanin in their cell walls, have become significant due to an increasing cause of human skin disease in Korea. The disease caused by dematiaceous fungi contain pityriasis (tinea) nigra, onychomycosis (in part), black piedra, keratomycosis (in part), chromoblastomycosis, phaeohyphomycosis, and eumycotic mycetoma (in part). Chromoblastomycosis is subcutaneous mycotic disease that contain sclerotic cells and histologically show pseudoepitheliomatous hyperplasia with microabscess, and phaeohyphomycosis is a group of mycotic infections that contain dematiaceous yeast-like cells, pseudohypae-like elements, hyphae or combination of these form in tissue.
Cell Wall ; Chromoblastomycosis ; Fungi* ; Humans ; Hyperplasia ; Hyphae ; Korea ; Melanins ; Mycetoma ; Onychomycosis ; Phaeohyphomycosis ; Piedra ; Pityriasis ; Skin Diseases

Scedosporium(S). apiospermum is the asexual stage of Pseudallescheria boydii. This ubiquitous fungus causes not only mycetoma but also infection of a variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection which occured in a 75-year old female. She had multiple suppurative nodules with pustules on a dark red plaque at the dorsum of the right forearm. Cultural isolation for definitive diagnosis showed typical S. apiospermum. The patient was treated successfully with oral terbinafine 250mg daily for 1 week and oral itraconazole 200mg daily for 3 weeks.
Aged ; Edible Grain ; Diagnosis ; Female ; Forearm ; Fungi ; Humans ; Itraconazole ; Mycetoma ; Pseudallescheria ; Scedosporium* ; Skin*