PMC3515922_01
Chronic osteomyelitis. A 48-year-old man with painless swelling of left foot. Frontal radiograph shows moth eaten area of destruction involving tarsal (white arrow) and metatarsals (black arrow) with patchy erosions and mild soft tissue swelling (yellow arrow).
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F1
Plain radiograph of the left foot showed mild soft tissue swelling with changes of chronic osteomyelitis involving the tarsal and metatarsals [Figure 1].
MRI T2 weighted coronal images show inflammatory changes with multiple soft tissue and osseus small hyperintense lesions with peripheral hypointense rim corresponding to mycetoma grains (yellow arrows). Few of them showing "dot in circle" sign (thicker white arrow).
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F2
Few of these lesions showed a central tiny hypointense focus suggestive of "dot in circle" sign [Figure 2].
(a) T2 weighted fat suppressed sagittal and (b) T1W fat suppressed postcontrast sagittal images show extension of inflammation proximally up to distal leg with ankle joint effusion (yellow arrow) and synovial thickening. "Dot in circle" sign (white arrow) is seen in postcontrast image.
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F3
T2-weighted fat saturated (T2W FS) and T1-weighted fat saturated (T1W FS) postcontrast images depicted the proximal extent of the lesion up to the distal half of the leg with ankle joint effusion and synovial thickening [Figure 3].
Histopathology slide prepared using lactophenol cotton blue shows septated conidia which is curved at 3rd cell from the base (yellow arrow) confirming the diagnosis of curvularia lunata (eumycetoma sp.) x1500.
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F4
The final microbiological test showed the presence of Curvularia lunata (Eumycetoma Sp.) [Figure 4].