Eumycetoma: A Perspective for Military Primary Care

Area of Science:

• Medical Mycology
• Infectious Diseases
• Case Reports

Background:

• Mycetoma is a chronic, granulomatous infectious disease affecting subcutaneous tissue, often caused by fungi or bacteria.
• It is endemic in tropical and subtropical regions, including Belize, and can have a long incubation period.
• Scedosporium apiospermum is a filamentous fungus known to cause mycetoma and other infections.

Observation:

• A 42-year-old woman presented with a 30-year history of progressive left foot and ankle swelling.
• Despite previous treatments and cultures, a definitive diagnosis of mycetoma was not established.
• Wound cultures eventually identified Scedosporium apiospermum as the causative agent.

Findings:

• The patient was treated with surgical debridement and oral antifungal medication.
• The case illustrates a delayed presentation of mycetoma, with symptoms appearing decades after the initial exposure.
• Scedosporium apiospermum was confirmed as the pathogen responsible for the mycetoma.

Implications:

• This case emphasizes the importance of considering mycetoma in the differential diagnosis for chronic, unexplained swelling, particularly in individuals with a history of travel to endemic areas.
• Military physicians should be aware of mycetoma as a potential diagnosis in service members returning from deployment zones where the fungus is prevalent.
• The indolent nature of mycetoma necessitates a high index of suspicion for timely diagnosis and effective management, even after long latency periods.