Eumycetoma of the Hand Caused by Leptosphaeria tompkinsii and Refractory to Medical Therapy with Voriconazole

We report on the first case of eumycetoma caused by the organism Leptosphaeria tompkinsii to be diagnosed and possibly acquired within the United Kingdom. Conventional culture of fungal grains and surgical tissue specimens was negative and the diagnosis was achieved using panfungal polymerase chain...

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Bibliographic Details
Published in:Mycopathologia (1975) 2011-10, Vol.172 (4), p.311-315
Main Authors: Cartwright, Katharine E., Clark, Tristan W., Hussain, Abid M., Wiselka, Martin, Borman, Andrew, Johnson, Elizabeth M.
Format: Article
Language:English
Subjects:
Antifungal Agents - administration & dosage
Ascomycota - isolation & purification
Biomedical and Life Sciences
Bones
Debridement
DNA, Fungal - genetics
Eukaryotic Microbiology
Fungi
Hand - diagnostic imaging
Hand - microbiology
Hand - pathology
Histocytochemistry
Histopathology
Humans
Infections
Infectious diseases
Leptosphaeria
Life Sciences
Male
Medical Microbiology
Microbial Ecology
Microbiology
Middle Aged
Molecular Sequence Data
Mycetoma - diagnosis
Mycetoma - microbiology
Mycetoma - pathology
Mycetoma - therapy
Organisms
Patients
Plant Sciences
Polymerase Chain Reaction
Pyrimidines - administration & dosage
Sequence Analysis, DNA
Sinuses
Tomography, X-Ray Computed
Treatment Failure
Triazoles - administration & dosage
United Kingdom
Voriconazole
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Summary:We report on the first case of eumycetoma caused by the organism Leptosphaeria tompkinsii to be diagnosed and possibly acquired within the United Kingdom. Conventional culture of fungal grains and surgical tissue specimens was negative and the diagnosis was achieved using panfungal polymerase chain reaction and sequencing technology. Despite limited surgical resection and prolonged antifungal therapy with voriconazole, the patient developed progressive disease with mycetoma bone involvement. This case highlights the usefulness of molecular diagnostic techniques in eumycetoma where organisms may fail to grow with conventional culture or be difficult to identify morphologically. It also reminds us that eumycetoma is a difficult infection to treat and despite optimism regarding the efficacy of the newer triazole antifungals in this condition, treatment failures may still occur.
ISSN:0301-486X
1573-0832
DOI:10.1007/s11046-011-9432-8