Lalchandani Rajesh, Salvi Bhavya V, D'souza Paschal, Gugnani Harish C
1Department of Orthopaedics, PGIMSR-ESI Hospital, Basaidarapur, New Delhi, 110015 India.
2Department of Dermatology, PGIMSR-ESI Hospital, Basaidarapur, New Delhi, India.
Indian J Orthop. 2020 Feb 10;54(2):224-227. doi: 10.1007/s43465-019-00031-3. eCollection 2020 Apr.
Mycetoma is a chronic, granulomatous infection mainly involving the foot and is caused either by bacteria (actinomycetoma) or fungi (eumycetoma). Eumycetoma is notoriously resistant, posing a therapeutic challenge. There are no specific treatment guidelines but generally a combination of systemic antifungals and local surgical treatment is the accepted standard. Advanced unresponsive lesions generally require amputation. We present a case of eumycetoma of 15-year duration with extensive involvement of foot including bones. Patient had been advised amputation from various tertiary care centers but we decided to give a limb salvage trial. The patient underwent soft tissue debridement along with oral antifungal therapy. Additionally, amphotericin B-impregnated bioabsorbable beads were inserted locally into the bony cavities to supplement the treatment. There has been no recurrence till date. This case is reported in view of successful limb salvage in an advanced eumycetoma case with an unprecedented use of adjunctive local antifungal delivery.
足菌肿是一种主要累及足部的慢性肉芽肿性感染，由细菌（放线菌性足菌肿）或真菌（真菌性足菌肿）引起。真菌性足菌肿具有众所周知的耐药性，这构成了治疗挑战。目前尚无具体的治疗指南，但一般来说，全身抗真菌药物与局部手术治疗相结合是公认的标准治疗方法。进展期无反应性病变通常需要截肢。我们报告一例病程长达15年的真菌性足菌肿病例，足部包括骨骼广泛受累。患者曾被多家三级医疗中心建议截肢，但我们决定进行保肢试验。患者接受了软组织清创术并辅以口服抗真菌治疗。此外，将两性霉素B浸渍的可生物吸收珠子局部植入骨腔以辅助治疗。迄今为止未出现复发。鉴于在一例晚期真菌性足菌肿病例中成功保肢，并前所未用辅助局部抗真菌给药方法，故报道此病例。
