A Case of Trauma-Induced Falciformispora lignatilis Eumycetoma in a Renal Transplant Recipient

Abstract

Mycetoma is a chronic, granulomatous, subcutaneous infection caused by several species of fungi and soil-inhabiting bacteria, and is divided into eumycetoma and actinomycetoma, respectively. Endemicity is described with worldwide distribution within the “mycetoma belt”; however, the global burden is ill-defined. Mycetoma is rare in Australia, with only a few published case reports. Over time, the breadth of eumycetoma pathogens has expanded with local epidemiology accounting for variations in regional prevalence. Direct inoculation of pathogens typically heralds the triad of subcutaneous mass, sinus formation and discharging grains. We describe a case of eumycetoma in a 48-year-old male Filipino renal transplant recipient who presented with a painless slow-growing elbow lesion. Ultrasonography revealed two ovoid masses and surgical excision ensued. Histopathology revealed necrotising granulomata with numerous chestnut-brown thick-walled cells, septate hyphae, and occasional grains. On suspicion of localised chromoblastomycosis, the isolate was sent to a reference laboratory which identified the fungus as Falciformispora lignatilis, an organism not hitherto associated with human infection. Amongst the solid organ transplant cohort, similar atypical presentations have been described. Clinicians need to consider eumycetoma where an epidemiological link with the tropics exists, especially in atypical presentations in transplant recipients, including absent preceding trauma.