Recurrent plantar eumycetoma in a young soldier managed with wide local excision and vacuum assisted closure: a rare case report

Abstract

Mycetoma was first reported in the year 1843 in Madurai, India by Dr. John Gill, and was then called “Madura foot”. The disease is caused by true fungi (Eumycetoma) or bacteria (Actinomycetoma). Commonly, affecting farmers in the tropical and sub-tropical regions, in contact with contaminated soil. The organism gets inoculated into the skin and soft tissue after minor trauma. It causes chronic progressive granulomatous inflammation, leading to destruction of skin and soft tissue characterised by classical triad of painless soft tissue swelling, multiple sinuses and discharge of grains. The treatment consists of early recognition, histopathological confirmation of causative organism, systemic antifungal therapy and surgical excision if not responding to medication. In this article, we present a rare case of recurrent Eumycetoma in a 34-year-old male. He had a history of Eumycetoma in 2018 affecting right foot, treated with systemic antifungals. A recurrent lesion occurred after approximately five years, affecting deeper muscle layers. MRI revealed no bony involvement. He was treated with oral Voriconazole, surgical excision and Vacuum-assisted closure of defect, with a favourable outcome. No recurrence noted upto one year of follow-up. Aim was to emphasize on diagnosis and management of Mycetoma, in cases presenting with classical triad of painless soft tissue swelling, multiple sinuses and discharge of grains, especially in young adults with history of minor trauma while in contact with soil. Early recognition, systemic antifungals with wide local excision leaving behind a healthy margin, followed by vacuum-assisted closure, a high protein diet and physiotherapy, can provide favourable outcome in treatment of Eumycetoma. Reconstructive surgical options can be explored for larger defects. Case report providing level IV evidence.