White Grain Eumycetoma due to Aspergillus flavus in Infancy: A Rare Case Report from Assam

Abstract

Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissue caused by traumatic inoculation of either fungi (eumycotic) or bacteria (actinomycotic). The disease is characterized by triad of tumefaction, discharging sinuses and grains. Here, we report a case of eumycetoma in an infant presenting with multiple discharging sinuses in lower limb. Aspirate and biopsy tissue from the sinuses were processed. The discharge revealed presence of white grains. Potassium hydroxide (KOH) mount revealed presence of hyaline septate hyphae. Histopathological examination showed granulation tissue and fungal hyphae. Repeated culture on sabouraud’s dextrose agar (SDA) with chloramphenicol showed growth of Aspergillus flavus on each occasion. Antifungal susceptibility testing was done following Clinical Laboratory Standard Institute (CLSI) M38-A2 protocol and showed high minimum inhibitory concentration (MIC) for fluconazole, caspofungin, anidulofungin and micafungin. The patient responded to itraconazole. Hence, exact categorization of lesion is essential for effective therapy and better prognosis.

Keywords

• aspergillus flavus
• eumycetoma
• white grain mycetoma