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[Mycetoma: attempt at intra-arterial management]
Summary
A severe mycetoma infection of the foot, caused by Madurella mycetomi, was treated with intraarterial miconazole nitrate. Despite initial attempts, amputation was ultimately necessary, highlighting the challenges in treating deep fungal bone infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Surgical Pathology
Background:
- Mycetoma is a chronic fungal infection, often affecting the extremities.
- Madurella mycetomi is a causative agent of mycetoma, posing significant treatment challenges.
- Previous surgical and systemic antimycotic therapies were ineffective for this patient's foot mycetoma.
Observation:
- A 28-year-old African student presented with a left foot mycetoma following a 1975 injury.
- Madurella mycetomi was identified in skin, pus, and bone samples.
- Intraarterial miconazole nitrate infusion via the posterior tibial artery was administered as a last resort before planned amputation.
Findings:
- Bacterial infection signs (fever, pain) appeared on day 23 of treatment.
- Fungal elements (Madurella mycetomi) were still detectable in bone tissue.
- Treatment cessation on day 30 due to catheter blockage led to inevitable foot amputation.
Implications:
- Intraarterial infusion of antimycotic agents may be considered for deep-seated mycetoma.
- Prompt intervention with intraarterial therapy is recommended for mycotic bone infections.
- Despite treatment failure, the patient was successfully fitted with a prosthesis and regained mobility.