Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region

Abstract

Background: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. Case presentation: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. Conclusion: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.

Molecular Background, Clinical Features and Management of Pediatric Mastocytosis: Status 2021

“…If symptoms persist, add-on of H2-antihistamines and/or cromolyn may be considered, especially for gastrointestinal symptoms, and leukotriene antagonists may also be considered in resistant cases [ 49 , 131 , 135 , 137 ]. Omalizumab, a monoclonal anti-IgE antibody, was shown effective as a third-line treatment option for mastocytosis, especially in patients with severe recurrent anaphylactic episodes [ 131 , 137 , 143 , 144 , 145 , 146 , 147 ]. In-label-use of omalizumab includes chronic spontaneous urticaria (≥12 years) and allergic asthma (≥6 years).…”

Mediator-Related Symptoms and Anaphylaxis in Children with Mastocytosis

“…Recently, omalizumab has been proposed for mastocytosis patients to treat severe mediator-related symptoms and to prevent anaphylaxis [ 3 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ]. The drug was indeed found to be effective in the prevention of recurrent episodes of idiopathic anaphylaxis in adults with mastocytosis [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], but has to be licensed for use only in children over 12 years of age. The results of the XOLMA study has shown that omalizumab was safe and improved mastocytosis symptoms like diarrhea, dizziness, flush, and anaphylactic reactions [ 103 ].…”

“…The drug was indeed found to be effective in the prevention of recurrent episodes of idiopathic anaphylaxis in adults with mastocytosis [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], but has to be licensed for use only in children over 12 years of age. The results of the XOLMA study has shown that omalizumab was safe and improved mastocytosis symptoms like diarrhea, dizziness, flush, and anaphylactic reactions [ 103 ]. First long-term follow-ups are available with improvement of clinical symptoms in two patients with SM and recurrent anaphylaxis over an observation period of 12 years [ 102 ].…”

Detection of slow growing Actinomadura species proved a key formanagement of mycetoma: A case report from Chhattisgarh

“…[ 2 ] Madurellamycetomatis is also reported from India as well as outside recently. [ 3 4 ] In India, there is wide variation in the cases, as eumycetoma is common in Rajasthan, whereas other states, namely, Andhra Pradesh, Punjab, Madhya Pradesh, Tamil Nadu, and West Bengal, Uttar Pradesh report most cases of actinomycetoma. [ 5 6 7 ] Because of the variation in the climate, socioeconomic factors, and the variations as well as lack of reporting of case in literature, epidemiology of India is undetermined.…”