Junior Resident, Department of Infectious Diseases, Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, West Bengal, India.
Associate Professor, Department of Infectious Diseases, Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, West Bengal, India, Corresponding Author.
J Assoc Physicians India. 2024 Aug;72(8):83-85. doi: 10.59556/japi.72.0531.
Mycetoma is a chronic skin and subcutaneous tissue infection characterized by a triad of localized swelling, draining sinuses, and grains or granules (composed of aggregations of the causative organism) within the sinus tracts. It is caused by filamentous higher bacteria (known as actinomycetoma) or fungus (known as eumycetoma). Usually actinomycetoma presents with white-yellow grains and majority of eumycetoma causes black grains. However, actinomycetoma caused by Streptomyces sp. produces large brown-black grain, which is often misdiagnosed as eumycetoma, therefore confirmation by culture is necessary. Here, we present a case of 28-year-old female presenting with typical features of mycetoma at cervicofacial region. On direct microscopy (40×) with potassium hydroxide (KOH) mount of discharge released from sinuses showed large and black grains, initially raising a suspicion of eumycetoma, but later, it was confirmed by culture as actinomycetoma caused by Streptomyces sp. Patient is now symptomatically better on treatment. Production of black grain by actinomycetoma is a rare clinical scenario.
足菌肿是一种慢性皮肤和皮下组织感染，其特征为局部肿胀、窦道排脓以及窦道内的颗粒或颗粒（由病原体聚集而成）。它由丝状高等细菌（称为放线菌肿）或真菌（称为真菌肿）引起。通常放线菌肿表现为黄白色颗粒，大多数真菌肿引起黑色颗粒。然而，由链霉菌属引起的放线菌肿产生大的棕黑色颗粒，常被误诊为真菌肿，因此需要通过培养来确认。在此，我们报告了一例 28 岁女性患者，其颈面部出现典型的足菌肿特征。直接镜检（40×）显示从窦道排出的分泌物的氢氧化钾（KOH）载片上显示出大而黑的颗粒，最初怀疑为真菌肿，但后来通过培养证实为链霉菌属引起的放线菌肿。患者目前在治疗下症状有所改善。放线菌肿产生黑颗粒是一种罕见的临床情况。
