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HERDIN Record #: NCR-JRRMMC-03261211033017 Submitted: 26 March 2012 Modified: 14 May 2012

Mycetoma of the hand: Dilemma in diagnosis and management.

Melito Ramos,
Florante P. Calacal,
Ferdinand P. Autea

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CONTEXT:
A patient with a complaint of multiple draining sinuses on the left hand that is non-functional as well. Physical examination of the hands showed the left hand fixed in extension with no appreciable range of motion seen at the wrist and finger joints. It also showed an enlargement of the left hand, described to be elephantiatic-type with fusiform swelling of the ring and index finger, with multiple draining sinuses associated with non foul smelling whitish to yellowish discharges on the volar and dorsal surface of the hand and wrist area.

STUDY DESIGN: Case Report

STUDY SETTING: Jose R. Reyes Memorial Medical Center

STUDY POPULATION: 27-year old male

MANEUVER:
Diagnosis is established by histology and cultivation of the microorganism. Therefore the necessity of good biopsy specimens taken for microscopic, mycologic, and bacteriologic examination and for culture can be overemphasized.

CONCLUSION:
We conclude that mycetoma should always be included in the differential diagnosis of chronic purulent processes, particularly if they are not susceptible to the method of treatment chosen, whether it be chemotherapy or surgical treatment or a combination of both. Determination of the possible causative agent of the Actinomycetoma is needed for proper medical management to be effective. However, special procedures are needed to arrive at a definitive causative agent, which was unavailable in our setting, where question of salvage over amputation of the extremity is deemed debatable. Increased awareness of actinomycosis, is required in the differential diagnosis of any subacute or chronic inflammatory lesion involving soft tissues and progressing to osteomyelitis in the hand.

Publication Type
Research Report
Date
LocationLocation CodeAvailable FormatAvailability
Medical Library, 5/F Training and Research Office, Jose R. Reyes Memorial Medical Center Abstract Print Format
 

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