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    (A) Multiple nodular swellings with sinuses discharging serosanguineous pus over the left foot. Three-dimensional volume-rendered reformatted computed tomography (CT) image (B) and sagittal CT image (C) show multiple osteolytic lesions (arrows) in tarsal and metatarsal bones. Fat-suppressed contrast-enhanced T1-weighted magnetic resonance image (D) showing diffuse hyperintensity (asterisk) and enhancement involving the metatarsal bones and surrounding soft tissues. Note sinus tract denoted by arrowheads. This figure appears in color at www.ajtmh.org.

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    Follow-up examination at 2 months after antibiotic treatment shows complete healing of the nodular lesions with no evidence of discharging sinuses. This figure appears in color at www.ajtmh.org.

  • 1.

    Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH, 2016. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis 16: 100102.

    • Search Google Scholar
    • Export Citation
  • 2.

    Bitan O, Wiener-Well Y, Segal R, Schwartz E, 2017. Mycetoma (Madura foot) in Israel: recent cases and a systematic review of the literature. Am J Trop Med Hyg 96: 13551361.

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    • Export Citation
 
 
 
 

 

 
 
 

 

 

 

 

 

 

Painless Progressive Swelling of the Foot with Discharging Sinuses (Madura Foot)

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  • 1 Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India;
  • | 2 Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar, India

A 40-year-old man, a laborer from Bihar (eastern India), presented to the surgical department with multiple large nodular swelling and discharging sinuses over the left foot with a duration of six months. These lesions began as small nodules that progressively increased in number and size and developed multiple sinuses. On examination, the swelling was painless and firm. He had no significant medical history. Computed tomography showed extensive osteolytic destruction of the tarsal and metatarsal bones. Magnetic resonance imaging demonstrated involvement of soft tissue with multiple sinus tracts (Figure 1). Gram staining from the discharging pus revealed actinomyces, a Gram-positive filamentous bacteria. The patient received co-trimoxazole for 2 months. Despite the widespread involvement of the bones and the soft tissue, all nodules resolved and the sinuses healed without significant deformity (Figure 2).

Figure 1.
Figure 1.

(A) Multiple nodular swellings with sinuses discharging serosanguineous pus over the left foot. Three-dimensional volume-rendered reformatted computed tomography (CT) image (B) and sagittal CT image (C) show multiple osteolytic lesions (arrows) in tarsal and metatarsal bones. Fat-suppressed contrast-enhanced T1-weighted magnetic resonance image (D) showing diffuse hyperintensity (asterisk) and enhancement involving the metatarsal bones and surrounding soft tissues. Note sinus tract denoted by arrowheads. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 5; 10.4269/ajtmh.21-0520

Figure 2.
Figure 2.

Follow-up examination at 2 months after antibiotic treatment shows complete healing of the nodular lesions with no evidence of discharging sinuses. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 5; 10.4269/ajtmh.21-0520

The term Madura foot or Mycetoma pedis is used to describe chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma).1,2 Both agents produce similar lesions and are characterized by the classic triad of a subcutaneous mass, sinus tract formation, and granular discharge. However, actinomycetoma is more aggressive and destructive and invades bone earlier than eumycetoma.1 Imaging studies are extremely helpful to delineate the extent of bone and soft tissue involvement. Microbiological diagnosis is essential because the treatment depends on the underlying etiology. Whereas eumycetoma may require surgical debridement in addition to antifungal therapy, most of actinomycetomas are successfully treated with antibiotics.2

REFERENCES

  • 1.

    Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH, 2016. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis 16: 100102.

    • Search Google Scholar
    • Export Citation
  • 2.

    Bitan O, Wiener-Well Y, Segal R, Schwartz E, 2017. Mycetoma (Madura foot) in Israel: recent cases and a systematic review of the literature. Am J Trop Med Hyg 96: 13551361.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Phulwari Sharif, Patna, Bihar, India 801507. E-mail: drrajeevnp@gmail.com

Disclosure: All procedures performed in study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from patient to publish this case report.

Authors’ addresses: Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India, E-mail: drrajeevnp@gmail.com. Manoj Kumar and Manoj Kumar, Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar, India, E-mails: drmano_mmc@yahoo.co.in and drmanojk@aiimspatna.org.

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