Dr. Rajesh Malhotra and colleagues have reported an interesting case of Madura’s foot labeling it as Weeping Leg. The case has appeared in the BMJ Case Reports.
According to history, a 37-year-old daily wager presented with multiple painless small nodules and granules discharging sinuses over the left leg. The lesions were uniformly distributed below the knee up to the ankle crease. His skin was puckered and tethered to the underlying tissues.
Surprisingly the foot and thigh of the involved limb and rest of the other limbs were absolutely symptom-free. His radiographs showed erosion of the entire tibia and fibula with mixed sclerotic and osteolytic areas along with sub tissue swelling and periosteal reactions.
Courtesy: BMJ Case reports
The culture of the grains in Modified Sabouraud Agar media supplemented with 0.5% yeast extract revealed Madurella mycetomatis from its characteristic colony of fruiting bodies.
Mycetoma is usually seen in foot, called ‘Madura foot’. Although Madura foot is more prevalent in the Southern India, this patient presented from the Northern region and neither gave any history of travel to the South in the past. On the other hand, the involvement of leg only with sparing of a foot is less common and was a rare presentation to us. We would like to give an eponym to this clinical condition as ‘Weeping Leg’ resembling the clinical presentation. Differential diagnosis includes chronic infections such as cutaneous tuberculosis, osteomyelitis (bacterial or tubercular), actinomycosis, chromomycosis and botryomycosis.
Bacterial infections are usually treated with antibiotics while the mycotic infections are resistant to antifungals. Moreover, once the bone is involved, surgical excision becomes necessary. As X-rays can pick up fairly advanced diseases only, an early radiological detection with CT and MRI is recommended for correct patient management.
Key messages are:
- Mycetoma is diagnosed late due to painless nature of the disease and late presentation of the patient.
- Clinical suspicion should be made with the triad presentation of painless soft tissue lesion, draining sinuses and extrusion of grains even if not in foot which typically is seen in.
For further reference follow the link: http://casereports.bmj.com/content/2018/bcr-2018-225567.full