Maduromycosis (Allescheria boydii) infection of the hand. A case report.
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A 4-year-old Santa Gertrudis cow had epistaxis and loud nasal sounds associated with nasal granulomas. Multiple cutaneous granulomatous nodules were on the ears and single ones on the tail, vulva and thigh. Helminthosporium sp. was isolated from cultured lesions; two isolates from the ear and nasal mucosa were identified as H. speciferum. Tissue sections stained with hematoxylin and eosin contained rounded forms ranging from 5X5 micronM to 12X19 micronM; an indistinct hyaline wall surrounded granules and vacuoles of varying size. Occasional transverse septa were present. Periodic acid-Schiff, Gomori's Methenamine Silver and Gridley's Fungus stain treated sections contained numerous smaller pleomorphic buds and a few branching septate hyphae attached to the rounded forms. Brown pigmentation of the wall was not a consistent finding.
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Maduromycosis is a chronic granulomatous condition caused by fungal infection and is rarely encountered in Europe. To our knowledge, this is the first report of a case of maduromycosis affecting the chest wall in the United Kingdom. Conservative excision and drainage of the lesion combined with ketoconazole treatment in a dose 400 mg daily for several months failed to cure the condition. However, radical excision of the lesion combined with myoplastic repair of the defect in the chest wall eradicated the disease. Maduromycosis can occur in the chest wall and should be suspected in the immigrant population from tropical and subtropical areas. We recommend radical resection of similar lesions, combined with prolonged treatment with an antifungal agent e.g. ketoconazole when the causative organism is madurella mycetomis.