A case of nocardia mycetoma occurring at the site of skin grafting

Abstract

Mycetomas are chronic infections of the skin, subcutaneous tissue and deeper tissues caused by fungi or filamentous bacteria and are characterized by tumefaction, nodules and sinuses. Eumycetomas are caused by fungi and actinomycetomas are caused by filamentous bacteria. Bacteria causing actinomycetomas are saprophytes found in soil, on plants, and on dead and decaying matter. They are aerobic, gram positive and weakly acid fast and form aggregates of micro colonies that appear as grains in the sinuses. Clinically, mycetomas present as areas of tumefaction with nodules and discharging sinuses. Bacterial mycetomas are sensitive to many antibiotics like penicillin, tetracyclines, sulphonamides, rifampcin, aminoglycocides etc, and long term combination therapies with variable success have been reported from different parts of the world. We have presented here a 23 year old male patient who presented with one year history of developing nodules and sinuses in the region of left flank. Patient had undergone skin grafting at the same site 3 years back for a wound he developed in the area following a road accident. He was unsuccessfully treated with antituberculous therapy elsewhere. He was admitted in our institute; the diagnosis of nocardia mycetoma was established and patient was successfully treated with complete clearance of lesions.

Keywords

• Nocardia
• mycetoma
• penicillin