[Actinomycetoma of the knee due to Nocardia otitidiscaviarum described in the Comoro Islands].

BACKGROUND

Mycetoma is a chronic skin and soft tissue infection encountered in the dry tropical regions and are caused by fungi (eumycetoma) or bacteria (actinomycetoma).

PATIENTS AND METHODS

A 25-year-old man consulted at the hospital on Mayotte Island for a left knee injury sustained 10 years earlier in a motorcycle accident with broken skin occurring in Anjouan in the Comoro Islands. Clinical and histological diagnosis of mycetoma was made, and in the absence of microbiological diagnosis, empirical antifungal therapy was initiated. Given the poor outcome, new biopsies were performed and resulted in the identification of Nocardia otitidiscaviarum. More than 1 year later, the patient had fully recovered and after administration of several and extended antibiotic courses including cotrimoxazole and linezolid.

DISCUSSION

Bacterial mycetomas are usually described in semi-arid regions and the occurrence of this disease is unexpected in humid tropical areas such as the Comoro Islands. N. otitidiscaviarum is rarely involved in this infection, particularly in Africa.