602

International Journal of Dermatology • August 1991

Vol. 30

Scalp Mycetomas in Saudi Arabia To the Editor: Mycetoma or "Madura foot" is not uncommon in Saudi Arabia. Although the lesions are mainly located on the foot, no site is exempt from the disease; however, involvement of the scalp is extremely rare. The following are thefirstease reports of mycetoma of the scalp from the Eastern Province. Only one similar case has been reported from Saudi Arabia to date.' Case Reports Case 1 A 20-year-old Yemeni man from Danimam presented with multiple cystic swellings on the right occipital region of the scalp of 3 years' duration. There were no discharging sinuses; x-ray showed no bone involvement. Biopsy of the lesion contained a number of firm, black granules of about 1-2 mm in diameter. When crushed and examined in a drop of potassium hydroxide, these were composed of thick, septate hyphae and large round vesicles, embedded in dark brown cement substance. Culture yielded Madurella mycetomati.s, which was confirmed by the Ameriean Type Culture Collection (ATCC 64942). Histologic examination revealed dark brown granules conforming to the description of A/, mycetomatis (Fig. 1) in microabseesses. Excision of the lesion along with ketoconazole, 200 mg twice daily for 1 year, resulted in complete cure without any recurrence after 6 months. Case 2 A 27-year-old Saudi man presented with a firm, painless, smooth, swelling on the forehead of 1 year duration; x-ray showed the presence of periosteitis. Excision of the swelling with cranioplasty was done. The excised tissue was sent for histopathologic examination, which revealed the presence of the characteristic granules of Slreplomyces somaliensis (Fig. 2). Culture was not done as the specimen was received in formalin. Comment Clinically mycetoma was not suspected in both the patients. The diagnosis of scalp mycetoma was made by histopathology. In addition, the causative agent was isolated in pure culturc from Case 1. Mycetoma of the scalp is rare. The incidence of head and neck involvement varies from 0.9% to 3.1% of myeetoma cases reported from Sudan, Senegal, Somalia, and Mexico.^ Lynch,-" in his study of 596 cases from Sudan, eneountered 18 cases with scalp lesions, 12 of

Figure 1. Tissue from Case 1 showing Madurella mycetomatis granule (H & E, original magnification xlOO).

Figure 2. Tissue from Case 2 showing Streptomyces somaliensis granules (H & E, original magnification X450).

which were due to S. somaliensis. Serrano et al."* and Chugh and Arora* reported one case of Scalp mycetoma each due to S. somaliensis out of 25 and 42 cases, respectively. Natarajan et al.' reported one case with cerebral lesion due to M. mycetomatis. Rahman' reported a case of cranial and epidural mycetoma due to S. somaliensis diagnosed by histopathology and serology. Although a fully developed mycetoma can be easily diagnosed, it may be difficult in the early stages, especially when the lesion is located at an unusual site. The cases are being reported to increase the awareness of the occurrence of the disease in unusual sites. Pankajalakshmi V. Venugopal, M.D., M.N.A.M.S., F.I.M.S.A. Taralakshmi V. Venugopal, M.D., M.N.A.M.S. William N. Laing, L.L.B., D.C.P., F.R.C. Path. Simon S. Namnyak, M.D., M.R.C. Path. Yaseen AL. Humaidan, D.V.D., D.D. Ali M. El. Bashier, D.C.P., M.R.C Path. Abdul Aziz Al. Jama, M.P.H., Sc.D. Hofuf, Saudi Arabia References 1. Rahman N Ur, Abdullah AK, Haloass NED, et al.: Cranial and epidural myeetoma caused by Sireplomyces somaliensis. Neuroradiology. 1987;29:95-97. 2. Mariat F, Destombes P, Segretain G: The mycetomas: Clinical features, pathology, etiology and epidemiology. Contrib Microbiol Immunol. 1977;4:l-39. 3. Lynch JB: Mycetoma in the Sudan. Ann R Coll Surg Engl. 1964;35:319-340. 4. Serrano JA, Beaman BL, Viloria JE, et al.: Histological and ultrastructural studies of human actinomycetomas. Sixth Int Symp on Actinomycetes Biology 1985;647-662. 5. Chugh TD, Arora DR: Mycetoma caused by Streptomyces somaliensis. Indian J Pathol Microbiol. 1975;18:49-53. 6. Natarajan M, Balakrishnan D, Muthu AK, et al.: Maduramycosis of the brain: Case report. J Neurosurg 1975;42:229-23L

Scalp mycetomas in Saudi Arabia.

602 International Journal of Dermatology • August 1991 Vol. 30 Scalp Mycetomas in Saudi Arabia To the Editor: Mycetoma or "Madura foot" is not unco...
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