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Eumycetoma of the Foot due to Fusarium solani in a Person with Diabetes Mellitus: Report of a Case and Review of Literature

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Abstract

Eumycetomas are chronic suppurative granulomas caused by fungi characterised by invasive tumefactive lesions, sinuses and discharging grains. Herein, we describe a case of pedal eumycetoma due to Fusarium solani sensu stricto in a person with diabetes mellitus. A 45-year-old gentleman presented with an insidious onset swelling over his right foot with nodules and discharging grains. He had received itraconazole and anti-tuberculous therapy elsewhere, without response. Re-evaluation included a biopsy which confirmed eumycetoma and newly diagnosed diabetes. Surgical excision followed by histopathological, microbiological and multigene sequencing analyses [translation elongation factor, calmodulin and internal transcribed spacer region of rDNA] of the mould on culture were performed. Histopathology revealed septate fungal hyphae amidst a dense inflammatory infiltrate (Splendore–Hoeppli) reaction. Oral voriconazole was started and good glycemic control attained. Tissue growth sequences showed > 99% similarity with Fusarium solani sensu stricto. Antifungal susceptibility testing showed lowest MIC to voriconazole (0.5 mg/L). The patient showed excellent response to combined therapeutic modality with a near-complete resolution in size of lesion and obliteration of sinuses following 4 months of therapy and is planned for prolonged voriconazole therapy till complete radiological resolution. Diabetes predisposes to fungal infections of foot but eumycetomas are uncommon. Combined surgery and antifungals can improve morbidity and avoid amputations.

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Acknowledgements

The authors wish to acknowledge Prof. Arunaloke Chakrabarti from the division of mycology, department of medical microbiology, PGIMER, for his support and guidance.

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There was no grant availed of, for this study.

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Authors and Affiliations

  1. Department of Endocrinology, PGIMER, 1012, Nehru Hospital Extension Block, Chandigarh, 160012, India

    Liza Das, Bhanu Malhotra, Ashu Rastogi & Pinaki Dutta

  2. Department of General Surgery, PGIMER, Chandigarh, India

    Divya Dahiya

  3. Department of Histopathology, PGIMER, Chandigarh, India

    Kirti Gupta

  4. Department of Radiology, PGIMER, Chandigarh, India

    Mahesh Prakash

  5. Department of Medical Microbiology, PGIMER, Nehru Hospital, Research Block A, Chandigarh, India

    Hansraj Choudhary & Shivaprakash M. Rudramurthy

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  1. Liza Das
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All authors contributed to the conception and design, acquisition of data, and/or analysis and interpretation of data and have read before the approval of the final manuscript.

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Correspondence to Shivaprakash M. Rudramurthy or Pinaki Dutta.

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11046_2020_524_MOESM1_ESM.tif

Supplementary Figure 1: The UPGMA clustering phylogram constructed using the sequences of translation elongation factor, calmodulin gene and internal transcribed spacer region of rDNA in Fusarium MLST database. (Data in the phylogram indicate the isolate of index patient) (TIFF 517 kb)

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Das, L., Dahiya, D., Gupta, K. et al. Eumycetoma of the Foot due to Fusarium solani in a Person with Diabetes Mellitus: Report of a Case and Review of Literature. Mycopathologia 186, 277–288 (2021). https://doi.org/10.1007/s11046-020-00524-y

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