Eumycetoma of the Hand Caused by <Emphasis Type="Italic">Leptosphaeria tompkinsii</Emphasis> and Refractory to Medical Therapy with Voriconazole |
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Authors: | Katharine E Cartwright Tristan W Clark Abid M Hussain Martin Wiselka Andrew Borman Elizabeth M Johnson |
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Institution: | (1) Department of Infectious Diseases, Infectious Diseases Unit, Leicester Royal Infirmary, Level 6 Windsor building, Leicester, LE1 5WW, UK;(2) Department of Clinical Microbiology, Leicester Royal Infirmary, Level 5 Sandringham building, Leicester, LE1 5WW, UK;(3) Mycology Reference Laboratory Bristol, Myrtle Road, Kingsdown, Bristol, BS2 8EL, UK; |
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Abstract: | 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. |
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