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Mycetoma Due to Aspergillus Flavus in a Diabetic Patient: Case Report and Literature Review Publisher



Kamali Sarvestani H1 ; Ahmadi B2 ; Gerami Shoar M1 ; Getso M1, 3 ; Rafat Z4 ; Mahmoudi S5 ; Khansari M6 ; Salahshour F7 ; Fatahi L8 ; Salehi M9 ; Ansari S10
Authors
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Authors Affiliations
  1. 1. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Medical Laboratory Sciences, School of Para-Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
  3. 3. Department of Medical Microbiology and Parasitology, College of Health Sciences, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria
  4. 4. Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
  5. 5. Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Radiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Pathology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  9. 9. Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  10. 10. Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: IDCases Published:2022


Abstract

Diabetes mellitus patients are prone to cutaneous and subcutaneous fungal infections due to pathogenic fungi, including dermatophytes, Mucorales, Candida, Aspergillus, and Fusarium species. Here, we report a case of A. flavus mycetoma confirmed by isolation and molecular identification. The case was a 38-year-old male farmer with a seven-year history of type 2 diabetes mellitus, living in Khuzestan, southwest of Iran. The patient presented with a right foot swelling associated with a nodule and multiple discharging sinuses following trauma sustained on the foot while working barefoot on the rice farm, a year ago. The nodule appeared at the site of the trauma two months after the injury. The initial diagnosis was based on direct microscopic examination of lesions scraping using 20% potassium hydroxide and radiology. Molecular analysis confirmed the isolates to be A. flavus. In vitro susceptibility of the isolate to voriconazole, posaconazole, caspofungin, itraconazole, and amphotericin B was determined. Treatment with voriconazole (200 mg twice daily) stopped the purulent discharge, reduced the swelling, and improved the clinical condition within two months. The study emphasizes the importance of wearing footwear to prevent skin trauma as the main risk factor of patient involvement. © 2022