Deep mycosis mimicking cutaneous squamous cell carcinoma

Area of Science:

• Medical Mycology
• Dermatology
• Infectious Diseases

Background:

• Deep cutaneous mycoses (DCMs) and other skin fungal infections lead to significant patient morbidity if not diagnosed and treated promptly.
• While immunocompromised individuals are susceptible to infections by *Candida*, *Aspergillus*, and *Fusarium* species, dermatophytes like *Trichophyton rubrum* and *T. mentagrophytes* are more prevalent.
• These infections manifest as superficial erythematous lesions that can progress to firm subcutaneous nodules, ulcers, abscesses, or sinus tracts, potentially causing osteomyelitis and bone loss in advanced stages.

Purpose of the Study:

• To highlight the diagnostic challenges and diverse clinical presentations of deep cutaneous mycoses.
• To emphasize the importance of considering DCMs in high-risk populations.
• To present a case study illustrating the varied clinical manifestations and diagnostic considerations for eumycetoma.

Main Methods:

• Review of clinical presentations, radiological findings, and microbiological cultures for diagnosing DCMs.
• Utilization of molecular methods to aid in the diagnosis of culture-negative cases.
• Histopathological examination of a suspected cutaneous squamous cell carcinoma lesion.

Main Results:

• DCMs can present with varied clinical features, including nodules, ulcers, and sinus tracts.
• Mycetoma, a form of DCM, is a chronic infectious disease affecting skin, subcutaneous tissues, and bones, endemic in certain regions.
• A case of eumycetoma in an immunocompetent farmer, initially misdiagnosed as squamous cell carcinoma, underscores the diagnostic complexity.

Conclusions:

• Accurate and timely diagnosis of DCMs is essential to prevent severe morbidity and complications.
• Diagnostic approaches should integrate clinical, radiological, and microbiological data, with molecular methods valuable for difficult cases.
• The heterogeneous presentation of DCMs necessitates a high index of suspicion, particularly in at-risk individuals, to ensure appropriate management.