By
Dr. Suresh B Parmeshwarappa
,
Prof. Anand Rao B H
Corresponding Author Dr. Suresh B Parmeshwarappa
Department of surgery, Kasturba Medical College, #180,B-type quarters, KMC campus, Manipal - India 576104
Submitting Author Dr. Suresh B Parmeshwarappa
Other Authors
Prof. Anand Rao B H
Department of Surgery, KMC, Manipal, KMC, Manipal - India 576104
Osteomyelitis, Great toe, Fungal, Phaeohyphomycosis
Parmeshwarappa SB, Rao B H A. Fungal Osteomyelitis Involving the Great Toe. WebmedCentral SURGERY 2012;3(1):WMC002907
doi:
10.9754/journal.wmc.2012.002907
This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Case summary
A 22 year old male presented with swelling and ulceration over the left great toe since six months. Patient, being an agriculturist by occupation, used to work in wet and damp soil. Initially he presented with swelling over the great toe followed by ulcer with discharging sinus containing black granules. There was no history of trauma. Patient was treated in local hospital, but with poor response to the treatment. The X-ray of left foot showed distortion and erosion of distal phalanx of great toe (Figure-1). Hematological and biochemical investigations were within normal limits. Patient was planned for amputation of great toe because of complete destruction of distal phalanx. Histopathology was reported as phaeohyphomycosis involving the bone.
Phaeohyphomycosis term was first introduced in 1974, meaning ‘‘condition of fungi withdark hyphae’’. It describes the brown to black color within the cell wall of the vegetativecells. Phaeohyphomycosis involves cutaneous, subcutaneous sites; paranasal sinus. Miscellaneous manifestations have included endocarditis, keratomycosis, endophthalmitis, peritonitis, various pulmonary presentations, osteomyelitis, rarely disseminated systemic infection (1). Infection occurs by molds found in soil, air, plants, organic debris. The most common route of exposure to humans is by means of inhalation or percutaneous inoculation (2). Phaeohyphomycosis is more of a histopathological diagnosis rather than a clinical entity. The different modalities of treatment of fungal osteomyelitis include chemotherapy with ketoconazole oritraconazole. Ketoconazole is the drug of choice. In case of failure of the antifungal therapy, radical treatment by surgical debridement or amputation may be required. In cases of chronic osteomyelitis with draining sinuses occurring in uncommon anatomic locations, fungal etiology should be suspected (3).
References
1. Silveira F, Nucci M (2001) Emergence of black moulds in fungal disease:Epidemiology and Therapy. Curr Opin Infect Dis14: 679-684.
2. Khan SA, Hasan AS, Capoor MR, Varshney MK, Trikha V (2007) Calcanealosteomyelitis caused by exophiala jeanselmei in an immunocompetent child. A casereport . J Bone Joint Surg Am 89(4):859-62.
3. Welsh O (1991). Mycetoma: Current concepts in treatment. Int J Dermatol 30: 387-98.
Source(s) of Funding
On behalf of all the authors, I certify that we have participated sufficiently in the conception and design of the study, the analysis of the data, and drafting and critical appraisal of the manuscript to take public responsibility for it. We have reviewed the final version of the manuscript and approve it for publication. Neither this manuscript nor one with sufficiently similar content under our authorship has been published, or is being considered for publication elsewhere, except as described in the enclosed article. We have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter of materials disclosed in the manuscript. I accept the responsibility for releasing this material on behalf of all coauthors.
Competing Interests
none
Disclaimer
This article has been downloaded from WebmedCentral. With our unique author driven post publication peer
review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is
completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript
but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before
submitting any information that requires obtaining a consent or approval from a third party. Authors should also
ensure not to submit any information which they do not have the copyright of or of which they have transferred
the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to
the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor
replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the
WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm
that you may suffer or inflict on a third person by following the contents of this website.