Mycetoma of the Hand and Arm Caused by Madurella

Report of a Case with a Review of the Literature

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  • The Barnard Free Skin and Cancer Hospital, Barnes Hospital, and Department of Medicine Division of Dermatology, School of Medicine, Washington University, St. Louis, Missouri
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A report is made of mycetoma of the hand and arm of 15 years' duration in a 64-year-old colored man who had lived on farms in Mississippi and Missouri all his life. A clinical and pathologic study of the lesions is presented. The histopathologic study revealed two types of reaction of the tissue to the organism, the one a foreign body type and the other a suppurative type. The organism forms dark brown to black granules in tissue. Gross and microscopic studies were made of the organism on various mediusm, as well as studies of its various biochemical reactions. The fungus is classified temporarily as Madurella ikedai Gammel, 1927, possibly synonymous with M. americana and M. mycetomi.

A review of the available world literature revealed that there have been at least 21 cases reported (including the present report) of mycetoma or mycetoma-like lesions involving the hand and/or arm. Of these, the etiology of three was not indicated; 11 were due to, or probably due to, actinomycetes; one was caused by a white-grained fungus; one was attributed to Aspergillus nidulans; one to Phialophora jeanselmei; one possibly to a red-grained Madurella; and two by species of Madurella. The case presented here represents the fourth Madurella infection of the hand and/or arm in the world literature and the first in a native of the United States.