mycoses 42, 345–346 (1999) Accepted: April 18, 1998

LETTER TO THE EDITOR

Case Report. Eumycetoma due to Curvularia lunata

Fallbericht. Eumyzetom verursacht durch Curvularia lunata

C. Janaki, G. Sentamilselvi, V. R. Janaki, Saraswath Devesh and K. Ajithados

Key words. Curvularia lunata, eumycetoma

Schlusselworter. Curvularia lunata, Eumyzetom

Summary. Eumycetoma caused by Curvularia and sinuses discharging black granules of 5 yearsduration. He gave a history of injury to the rightlunata affecting the right foot is described in a

27-year-old farmer with the mycological and foot in the form of being run over by a bullockcart. Six months later the patient noticed a swellingmycopathological features. The patient was being

treated with oral ketoconazole 200 mg daily for on the dorsum of the right foot with sinusesdischarging black granules at the site of injury,2 months and followed.followed by the development of multiple nodules

Zusammenfassung. Es wird ein Eumyzetom, and sinuses involving the entire foot including theverursacht durch Curvularia lunata, am rechten Fuß sole. He also underwent a surgical excision of oneeines 27 Jahre alten Farmers beschrieben. Der of the sinuses.Patient wurde oral mit 200 mg Ketoconazol taglich Systemic examination did not reveal any abnor-behandelt. mality. Dermatological examination showed a

diffuse swelling involving the dorsum of the rightfoot extending over the medial aspect of right sole

Introduction to the posterior aspect of the leg (Fig. 1). Multiplenodules and sinuses discharging black granules

Mycetoma is a chronic infectious disease charac- were seen. The healed sinuses had left behindterized by swelling, draining sinuses and discharge puckered scars. The skin over the entire foot wasof sclerotia or grains. Mycetoma caused by truefungi has been encountered less frequently whencompared with those caused by actinomycetales[1]. There are 31 species of fungi known to causemycetoma and they are isolated from soil andwoody plants [2]. A case of eumycetoma causedby Curvularia lunata, one of the rarer causativeagents is described here.

Case report

A 27-year-old male farmer came for treatment fora swelling of the right foot with multiple nodules

Mycology Section, Department of Dermatology, MadrasMedical College, Madras, Tamilnadu, India.

Correspondence: Dr G. Sentamilselvi, No. 7, 78th Street,Sector-12, K. K. Nagar (West), Madras, 600 078 Figure 1. Eumycetoma due to Curvularia lunata. Swelling of right

foot showing sinuses discharging black granules.Tamilnadu, India.

346 C. Janaki et al.

hyperpigmented and thickened. Regional lymphnodes did not show any significant enlargement.

All the routine investigations including haema-tological and biochemical tests were normal.Enzyme-linked immunosorbent assay for HIVinfection was found to be negative. Mycologicalexamination of the grains in 10% potassiumhydroxide (KOH) solution revealed black-fissuredmasses with brownish septate hyphae. Culture ofthe granules on Sabouraud glucose peptone agarwithout cycloheximide revealed the growth ofblack colonies with white areal hyphae.Microscopic examination showed septate hyphaeas well as conidia of Curvularia lunata which wereidentified by the characteristic morphology. The

Figure 2. Skiagram of right foot revealing osteolytic changes inconidia were four-celled with three septae and hadthe calcaneum and tarsal bones.

a larger subterminal cell [3]. Biopsy section of anintact nodule stained in haematoxylin and eosin ketoconazole therapy with resolution in the size of(H&E) showed bean-shaped grains with basophilic swelling and cessation of formation of freshcentres and a dark periphery showing mycelia nodules.along with neutrophilic infiltrate.

A skiagram of the right foot revealed soft tissueswelling along with osteolytic changes in the cal- Referencescaneum and tarsal bones (Fig. 2).

The patient was treated with oral ketoconazole 1 Kamalam, A. (1984) Observation on the gamut/galaxyof the fungal infection in Tamilnadu state. Kavaka 12,200 mg daily for 2 months which was followed by15–36.improvement as shown by the reduction of the

2 McGinnis, M. R. (1996) Mycetoma. In: Elgart, M. L.swelling with resolution of the sinuses and com-(ed.) Dermatologic Clinics, Vol. 14. Philadelphia, London:plete cessation of formation of new nodules. W. B. Saunders Publications, pp. 97–104.

3 de Hoog, G. S. & Guarro, J. (1995) Atlas of clinical fungi.Reus: CBS, Baarn and Delft, and Universitat Rovirai Virgili.Discussion

4 Venugopal, P. V. & Venugopal, T. V. (1994) Deep fungalinfections. In: Valia, R. G. (ed.) IADVL Text and Atlas of

Madurella mycetomatis and Madurella grisea were Dermatology, Vol. 1. Chapter 12. Bombay: Bhalaniobserved to be the common agents causing black Publishing House, pp. 213–236.

5 Venugopal, P. V., Venugopal, T. V. & Pandurangan,grain mycetoma [1, 2, 4]. Other agents such asC. N. (1980) Leptosphaeria senegalensis causing mycetomaLeptosphaeria senegalensis [5] and Leptosphaeria tompkin-pedis in Madras. Indian J. Dermatol. Venereol. Leprol. 46,sii [6] producing black grains are less frequently364–367.isolated. Pale-grain-producing fungi such as 6 Venugopal, P. V., Venugopal, T. V. & Pandurangan,

Pseudallescheria boydii, although common in the USA C. N. (1990) Leptosphaeria tompkinsii mycetoma. Int. J.Dermatol. 29, 432–433.and Canada, are occasionally found to be the

7 Venugopal, P. V. & Venugopal, T. V. (1995) Pale graincausative agent in India, as also are Acremoniumeumycetomas in Madras. Aust. J. Dermatol. 36, 149–157.spp. [7].

8 Elad, D., Orgal, U., Yakobson, B. et al. (1991)Curvularia spp. have been found to produce Eumycetoma caused by Curvularia lunata in a dog.

visceral [8] and granulomatous lesions [9] in ani- Mycopathologia 116, 113–118.9 Russo, A. M., Ebermayer, S. E., Mancebo, A. & Monzou,mals. Cutaneous and systemic infections due to

C. M. (1994) Eumycotic mycetomas in horses caused bythis agent were reported both in immunocompe-Curvularia verruculosa Revista Argentina de Microbiologiatent and immunocompromised individuals [10].26, 179–182.

Curvularia lunata had been isolated from a black 10 Yau, Y. C., de Nanassy, J., Summerbell, R. C., Matlow,nail of a female from our centre [11], but this A. G. & Richardson, S. E. (1994) Fungal sternal wound

infection due to Curvularia lunata in a neonate with congeni-species has not been encountered as a cause oftal heart disease, case report and review. Clin. Infect. Dis.mycetoma so far in India to our knowledge. The19, 735–740.infection could have been due to the contaminated

11 Kamalam, A., Ajithados, K., Sentamilselvi, G. &wooden splint from the cart wheel during the Thambiah, A. S. (1992) Paronychia and black discolor-injury, since this species is commonly found in soil ation of a thumb nail caused by Curvularia lunata.

Mycopathologia 118, 83–84.and woody plants. Our patient is improving with

mycoses 42, 345–346 (1999)