case_images: PMC10550213_01
case_images: Microbiological and histopathological findings; (A) Grain in hematoxylin and eosin stain; (B) Grain in periodic Acid-Schiff stain; (C) Grain in Fite-Faraco stain; (D) Direct microcopy with 40% potassium hydroxide showing white homogenous grain; (E) Colonies of Gordonia soli in blood agar medium culture after 72 h of incubation at 30oC.
case_images: 1678-9849-rsbmt-56-e0326-2023-gf1.jpg
case_images: PMC10550213_01_1678-9849-rsbmt-56-e0326-2023-gf1.jpg
case_images: f1
case_images: It was also remarkable for the presence of grains and filamentous structures compatible with an actinomycetoma (Figure 1-A, B,C). A new specimen was obtained from the secretion, and the grains were observed using direct microscopy (Figure 1-D).
case_images: Clinical features; (A) Nodular lesions on left foot compatible with mycetoma; (B) Recurrence of symptoms after several years of medical treatment; (C) Magnetic resonance imaging (MRI) of left foot, revealing high-signal areas on fat-saturated T2 weighted sequence in the subcutaneous tissue and midfoot bones. Red arrow indicates tiny hypointense foci within hyperintense spherical lesions, known as the "dot-in-circle" sign.
case_images: 1678-9849-rsbmt-56-e0326-2023-gf2.jpg
case_images: PMC10550213_01_1678-9849-rsbmt-56-e0326-2023-gf2.jpg
case_images: f2
case_images: The patient was treated with trimethoprim-sulfamethoxazole (TMP-SMX) for eight years, without complete resolution of symptoms, as he had persistent painful nodular draining lesions (Figure 2-A). Four years later, the patient experienced pain recurrence, edema, purulent discharge, and elimination of grains through the fistulas (Figure 2-B). The "dot-in-circle" sign was present, which is suggestive of mycetoma (Figure 2-C).