Mycétome fongique de la main : à propos du premier cas tunisien

A 48-year-old agricultural worker presented with a swelling and painless cutaneous nodules of the right hand and wrist that drained spontaneously. No trauma of the hand was noted. Examination of the hand revealed multiple crusted sinus tracts in the palm and on the back of the hand. The right hand appeared swollen and deformed. There was no adenopathy or fever. Radiographic examination showed bone involvement with destruction of the wrist bones. The diagnosis of eumycetoma was confirmed by histological evidence (stained sections) that showed granules containing fungal hyphae and positive culture for P. boydii. Initially, treatment with ketoconazole (400 mg daily for 14 months) failed. The patient subsequently received itraconazole (400 mg daily for 18 months) and a marked improvement was obtained. Six years after treatment was stopped, there had been no recurrence, but bone involvement resulted in permanent deformity with wrist ankylosis.