Maduramycosis

Case contributed by Dr Arvind Aggarwal

Presentation

Painless swelling with multiple sinuses involving left foot for 3 years.

Patient Data

Age: 52 year
Gender: Male
X-ray

Radiographs of left foot demonstrate very advanced bony destruction, with a palisade type of periosteal reaction, with multiple sinuses and cortical erosions mainly involving tarsal and metatarsals .

MRI

Selected images form an MRI of  left foot demonstrate a soft tissue mass involving the left foot, the mass showed conglomerate areas of multiple, discrete, small 2–5 mm round hyperintense lesions, which were separated by a low-signal-intensity rim and central hypointense dot  infiltrating the adjacent muscles.

T2-weighted MRI revealed diffuse hyperintensity involving the subcutaneous tissue, muscles, and intermuscular fascial planes, with multiple pockets of fluid collections with overlying skin ulceration . Also, multiple small discrete spherical hyperintense lesions were noted, which were divided by a network of low-intensity soft tissue. In the centre of some of these lesions, there was a tiny hypointense focus, resulting in the dot-in-circle sign. Small conglomerated low intensity foci and micro-abscesses were also seen at other sites.  

Pathology

Haematoxylin and eosin (H&E) stain: fungal organisms surrounded by granulation tissue. 

Case Discussion

This cases demonstrates fairly typical appearances of advanced Madura foot (maduromycosis),  of three years duration. 

Maduramycosis is a chronic granulomatous fungal disease affecting lower limbs especially the foot . Disease is caused by the filamentous fungi which when introduced into the human body by prick of infected thorn or splinter. Typical clinical findings of the disease helps to make a diagnosis which includes , painless wound involving the part of a limb with multiple discharging sinuses for a long time , having yellow coloured discharge resembling small grains which are, in fact, clumps of fungi (also found in biopsy).

Furthermore, as these fastidious organisms sometimes are difficult to demonstrate either on biopsy or microbiological culture, or when the clinical and biopsy findings are equivocal  , MRI scan helps to make the diagnosis.

The recently described "Dot in circle sign" is the characteristic for madura foot. 

PlayAdd to Share

Case information

rID: 29099
Case created: 3rd May 2014
Last edited: 18th Sep 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.