A healthy 35-year-old man from Mauritania presented to the dermatology department with a several-year history of evolving lesions on his back (Figure 1). The patient, a rural shepherd without local access to health care, did not recall any specific injury at the infection site. A physical examination was notable for a painless subcutaneous mass, multiple sinuses, and discharge containing grains. No systemic symptoms were identified. Material from a back lesion was obtained for microbiological studies. Black grains were visualized by using direct microscopy. A diagnosis of eumycetoma (mycetoma caused by fungi) was made.1 Supplies for performing a fungal grain culture, a punch biopsy, histopathology, and molecular diagnostics were unavailable; therefore, the genus and species could not be identified. Antifungals, including itraconazole, were not available through the public health care system, and the patient was unable to afford antifungals from a private pharmacy. The patient returned to his home in rural Mauritania and was lost to follow-up.
Eumycetoma on the back.
Citation: The American Journal of Tropical Medicine and Hygiene 112, 5; 10.4269/ajtmh.24-0699
REFERENCE
Ahmed AA, van de Sande W, Fahal AH, 2017. Mycetoma laboratory diagnosis: Review article. PLoS Negl Trop Dis 11: e0005638.