A 40-year-old man from Maharashtra presents with a chronic swelling of the foot with multiple draining sinuses discharging white granules (sulphur granules). Microscopy of the granules shows branching filaments with a club-like fringe (Splendore-Hoeppli phenomenon). What is the most likely organism and treatment?
- A Madurella mycetomatis (eumycetoma); surgical excision + itraconazole ✓
- B Actinomyces israelii (actinomycetoma); penicillin G or amoxicillin
- C Nocardia brasiliensis (actinomycetoma); co-trimoxazole (TMP-SMX)
- D Sporothrix schenckii; itraconazole
Explanation
Madura foot (mycetoma) with white granules and Splendore-Hoeppli phenomenon (eosinophilic coating of granules by Ig deposits) in a patient from the endemic Indian region (Maharashtra/Rajasthan) is consistent with eumycetoma caused by Madurella mycetomatis (the most common cause in India). Eumycetoma is caused by true fungi and managed with itraconazole for years, often combined with surgical debulking/excision. Actinomycetoma (Actinomyces, Nocardia, Streptomyces) is bacterial and treated with antibiotics. White granules in eumycetoma may also be seen with Pseudallescheria boydii.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.