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Case Reports
. 2015 Jan-Mar;10(1):56.
doi: 10.4103/1793-5482.151524.

Atypical craniocerebral eumycetoma: A case report and review of literature

Kommu Venkateswara Rao  1 , Ankathi Praveen  1 , Santhavir Megha  1 , Challa Sundaram  1 , Anirudh Kumar Purohith  1
Affiliations
Case Reports

Atypical craniocerebral eumycetoma: A case report and review of literature

Kommu Venkateswara Rao et al. Asian J Neurosurg. 2015 Jan-Mar.

Abstract

Craniocerebral eumycetomas are rare. They usually present with scalp swelling and discharging sinuses. Radiologically, they present as space-occupying lesions. We report a case of eumycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male, farm laborer, who presented with seizures and blurring of vision. Imaging showed a dural based lesions enhancing moderately on contrast. To the best of our knowledge and belief, ours is the first published case in the English Literature where a eumycetoma has presented as a mass lesion without discharging sinuses. It is imperative to keep such atypical features of an infective etiology in mind because they may be one of differentials of "dural" based lesions where only a biopsy may suffice in the absence of significant mass effect to prove the diagnosis.

Keywords: Cranium; eumycetoma; fungal granuloma; osteomyelitis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
CT scan brain showing left parietal bone hyperostosis with subdural collection, focal cerebral oedema, mass effect, midline shift and small hyper densities in parietal lobe
Figure 2
Figure 2
(a&b) MRI brain T1W and T2W axial section showing relieved mass effect with subcutaneous collection at operative site and no parenchymal lesion. (c, d and e) T1W post contrast of brain showing enhancement of subcutaneous collection at operative site
Figure 3
Figure 3
(a) Intraoperative picture showing subcutaneous tissue entering into brain through small whole in parietal bone (no external sinus to the skin). (b) removed parietal bone with bony destruction and punched out appearance
Figure 4
Figure 4
(a) photomicrograph showing granule with pale center and splender-hopple phenomenon amidst suppurative inflammation. Hematoxylin and eosin ×4 Inset showing eosinophilic material in the periphery of the granule with neutrophils clinging to it Hematoxylin and eosin ×40. (b) Photomicrograph showing filamentous hyphae in the center of the granule periodic acid schiff ×40. (c) Photomicrograph showing filamentous hyphae in the centre of the granule and vesicles in the periphery-Gomori s methenamine silver stain ×40
See this image and copyright information in PMC

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