Human ; Male ; Adult: 25-44 Yrs Old ; Madura Foot ; Mycetoma

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.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Mycetoma

Aspergillosis ; Ethics Committees, Research ; Fungi ; Humans ; Korea ; Magnetic Resonance Imaging ; Mycetoma ; Paranasal Sinuses ; Retrospective Studies ; Sinusitis

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

Herein, we describe the case of a 67-year-old female patient who presented with cough and haemoptysis. Chest computed tomography revealed destruction of the left lower lobe and multiple fungus balls in a bronchiectatic cavity. A left lower lobectomy was performed via thoracotomy. Histopathological examination of the lung showed a concomitant aspergilloma and multiple tumourlets in the large bronchiectatic cavity. Pulmonary intracavitary aspergilloma and concomitant tumourlets are quite rare. Our report presents this interesting case that manifested with haemoptysis.
Aged ; Bronchiectasis ; Cough ; Female ; Fungi* ; Hemoptysis ; Humans ; Lung ; Mycetoma ; Pulmonary Aspergillosis ; Thoracotomy ; Thorax

Mycetoma is a chronic, debilitating, granulomatous disease affecting the subcutaneous tissue, fascia, muscle, bone and adjacent organs characterized by triad of tumefaction, draining sinus, and grains. The ten-year incidence in our institution from 2000 to 2010 is 3 out of 81,015 cases. We present a 33-year-old man with a nine-year history of painless nodules and draining sinuses on the left foot which were unresponsive to oral antibiotics and topical antifungals. Biopsy of a nodule was consistent with mycetoma. Fungal culture revealed Madurella mycetomatis growth confirming eumycetoma. X-ray of the left foot showed poorly marginated lucencies on the calcaneus and navicular bones. Ultrasound revealed mixed hyperreflective echoes and multiple small cavities. We diagnosed the patient with Stage III eumycetoma based on the radiographic classification of bone involvement and prescribed oral ketoconazole 400 mg daily for nine months achieving 50-60% decrease in lesion size. Surgical debulking was done and ketoconazole was continued at the same dose for another nine months. There was good granulation tissue formation and no appearance of new lesions after surgery.

Human ; Adult ; Anti-bacterial Agents ; Calcaneus ; Cytoreduction Surgical Procedures ; Fascia ; Foot ; Granulation Tissue ; Ketoconazole ; Madurella ; Mycetoma ; Subcutaneous Tissue ; Ultrasonography

Candida species is indigenous fungus of healthy individuals, and frequently found in sputum culture. Candida isolation from the respiratory tract is not generally considered as a marker of lung infection, and definitive diagnosis of Candida pneumonia is confirmed by tissue biopsy. A few cases of Candida pneumonia pathologically confirmed by transthoracic needle aspiration of mycetoma have been reported. In Korea, a case of Candida pneumonia diagnosed by bronchial washing and blood culture was reported, but there is no case report diagnosed by biopsy. We report a case of Candida pneumonia diagnosed by endobronchial biopsy, and antifungal therapy resulted in successful resolution of the pneumonia.
Biopsy* ; Candida albicans* ; Candida* ; Diagnosis ; Fungi ; Korea ; Lung ; Mycetoma ; Needles ; Pneumonia* ; Respiratory System ; Sputum

Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal infection of the paranasal sinuses that are usually seen in young immunocompetent patients with atopy and/or asthma. Fungus balls can grow in moist cavities of the paranasal sinuses of a host with normal immunologic status. Cases of AFRS with concurrent fungus balls is very rare. We present a case of a patient who had AFRS on one side of the paranasal sinus and allergic fungal sinusitis on the other side. A 51-year-old female with atopy presented with a few-year history of nasal obstruction and rhinorrhea, as well as a history of high-dose systemic steroid therapy. The patient had nasal polyps and showed an elevated level of total IgE and positive MAST to fungal antigens. Endoscopic sinus surgery was performed. Allergic mucin from the right maxillary sinus contained sheets of eosinophils and Charcot-Leyden crystals. Also, a clay-like dark brown material from the left maxillary sinus was revealed to be a fungus ball.
Antigens, Fungal ; Aspergillosis ; Asthma ; Eosinophils ; Female ; Fungi* ; Humans ; Immunoglobulin E ; Maxillary Sinus ; Middle Aged ; Mucins ; Mycetoma ; Nasal Obstruction ; Nasal Polyps ; Paranasal Sinuses ; Sinusitis

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.
Agar ; Aged, 80 and over ; Base Sequence ; Biopsy ; Fluconazole ; Fungi ; Glucose ; Hand ; Humans ; Male ; Mycetoma ; Pseudallescheria ; Scedosporium* ; Sequence Analysis, DNA* ; Sewage ; Skin* ; Soil

Scedosporium apiospermum, an asexual state of Pseudallescheria boydii, is a widely distributed mould that can be found in the soil, manure, stagnant water and decaying vegetation. It has become an emerging pathogen among immunosuppressed patients but it can also cause infections in immunocompetent patients by penetrating trauma. This fungus is a classical cause of mycetoma and the localized skin infections caused by this mould are much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection in a 79-year-old woman. She had erythematous plaque with crust and violaceous supprative nodules on the right forearm. The culture from pus showed typical white to gray colored cottony colonies of S. apiospermum. Treatment was started with voriconazole effectively. Skin lesions completely cured with no reccurence. Thus, voriconazole shows to be an effective treatment for Scedosporium infection.
Female ; Forearm ; Fungi ; Humans ; Manure ; Mycetoma ; Pseudallescheria ; Pyrimidines ; Scedosporium ; Skin ; Soil ; Suppuration ; Triazoles