Oral eumycetoma of infancy: a rare presentation and a brief review

A Rare Case of Oral Cavity Eumycetoma

Rationale

Mycetoma is a chronic granulomatous infection that involves the skin and subcutaneous tissue which presents as an abscess with multiple draining sinuses. It is common in the tropical and subtropical regions where the conditions favour the growth of the soil saprophytes - fungi and bacteria.

Patient Concerns

We report the rare case of a 62-year-old patient who presented with a soft-tissue overgrowth in the mandibular posterior ridge area for eight months.

Diagnosis

The patient was diagnosed with eumycetoma, with foreign-body reaction based on clinical and histopathological examination which revealed characteristic brown-coloured amorphous grains.

Treatment

The lesion was surgically excised under local anaesthesia.

Outcomes

On the seventh day post-operative follow-up, the patient was relieved of pre-operative symptoms and the surgical site had healed well.

Take-Away Lessons

This particular case of eumycetoma had an unusual site and appearance, making the clinical diagnosis confusing with other reactionary lesions of the oral cavity.

Mycetoma: a clinical dilemma in resource limited settings

Background

Mycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initiation. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested.

Main text

An overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided. Since treatment is currently based on expert opinion, we encourage active research to establish treatment guideline for it.

Conclusion

Since delay in visiting health facility results into gruesome complication, early presentation, recognition and initiation of appropriate choice of regimen is helpful in reducing complications. The clinical overview of mycetoma and the suggested algorithm may enhance suspicion and possibly increase recognition of mycetoma in the community and further guide in differentiation of eumycetoma from actinomycetoma. There is an urgent need for research funding for mycetoma, a disease plagued by severe physical disabilities and social stigma leading to isolation.

Electronic supplementary material

The online version of this article (10.1186/s12941-018-0287-4) contains supplementary material, which is available to authorized users.

Head and neck mycetoma: the mycetoma research centre experience

Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.