Cytodiagnosis of Primary Actinomycotic Mycetoma of The Foot: A Case Report

Abstract

Mycetoma is chronic suppurative granulomatous disorder of subcutaneous tissue characterized by localized swelling with multiple discharging sinus tracts of granules that are micro colonies of the causative agent. Madura foot/mycetomas are the infection caused by true fungi (eumycetoma) in 40% or filamentous bacteria (actinomycetoma) in 60% of the cases. Painless subcutaneous mass, multiple sinuses and purulent or seropurulent discharge that may contain grains is characteristic of mycetoma. Mycetomas are usually diagnosed on histopathology. There are very limited data on role of fine-needle aspiration cytology (FNAC) in diagnosing these lesions. The distinction between eumycetoma and actinomycetoma in FNAC is as accurate as histopathology. Herein, we report a case of primary actinomycotic mycetoma of right foot in 65-year-old male patient. FNAC of soft tissue mass was advised, which revealed mixed inflammatory infiltrate with clumps of fibrillar organisms and occasional foreign body giant cells. Cytodiagnosis of actinomycetoma was rendered and Gram-stain was done later demonstrated Gram-positive thin branching filaments. Mycetoma can be accurately diagnosed by FNAC in outpatient department, which is simple, inexpensive, routine procedure for rapid diagnosis, and differentiation of etiology as the treatment differs.

A Surprise in the Left great toe

“…Since it is a disease of poor socio economic conditions morbidity rates are high with low mortality rate . [3] Madura foot, caused by fungi eumycetoma are saphrophytics which are found in soil. Madurella mycetomatis is the most common eumycetoma causative microorganisms.…”

“…In FNAC, the eumycotic mycetoma which will appear septate with branching hypae with black granules in an inflammatory background. [3] Histopathologically ,the dermis and subcutaneous tissue show localized abscesses composed of lymphoid cells, plasma cells, histiocytes. Each of these abscess contains the granules and fungal colonies in the centre.…”