Eumycetoma diagnosed in urban Australia

A 79‐year‐old Indian man who immigrated to Australia in 1976 presented with a 15‐year history of left wrist swelling and forearm sinus tracts (Figure). He travelled to India four times up to 2010, where he denied soil‐contact activities. Although uncertain, we believe he acquired the infection in Australia from gardening.

Differential diagnoses include entomophthoromycosis, sporotrichosis, mycobacterial infections and sarcoma.1 Biopsy showed fungal hyphae and spores. Fungal polymerase chain reaction (PCR) was positive for Trematosphaeria grisea. Fungal cultures were negative, including extended incubation at 30°C. He commenced itraconazole and treatment continues.

Eumycetoma is rare in Australia; one case was previously reported in Queensland.2 PCR allows rapid and reliable species identification.1 Treatment consists of prolonged triazole antifungals often combined with surgery.1 Complications if untreated include bacterial infection, pain and deformity.1