Black grain eumycetoma of the breast-misdiagnosed, incidental or iatrogenic?

Pragya Ashok Nair, Rahulkrishna S Kota

 Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat, India

Correspondence Address:
Pragya Ashok Nair
Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad - 388 325, Gujarat
India

Sir,

We read with great interest the article, "Black grain eumycetoma misdiagnosed as fibroadenoma" which appeared in the September-October 2015 issue of Indian Journal of Dermatology, Venereology and Leprology. ^[1]

The authors stated that the patient had initially developed a solitary asymptomatic subcutaneous nodule in the right inferomedial quadrant of the breast followed by a similar lesion in the central quadrant which was diagnosed as a fibroadenoma by a surgeon. Excision biopsy of the central nodule showed features of fibrocystic disease. At the same time, the inferomedial nodule was also excised but histopathological examination was not performed for this nodule. Later, the patient developed multiple nodules which showed a granulomatous inflammatory reaction and round to oval granules containing fungal colonies on excision biopsy, features of eumycetoma.

The time gap between excision of the inferomedial nodule and development of newer nodules has not been mentioned by the authors. We believe the initial excision biopsy might have acted as the initiating factor leading to implantation of the causative fungus. The occupation of the patient was not mentioned. Mycetoma typically presents in people who walk barefoot in dry, dusty conditions. Minor trauma causes the pathogens to enter the skin from the soil. ^[2],[3]

Another possibility is that the first two nodules were unrelated, the central nodule being fibrocystic disease as diagnosed on biopsy and the inferomedial nodule being a eumycetoma. The incubation period varies from weeks to several years in mycetoma. Following implantation of the organism, a painless nodule slowly develops and gradually increases in size.

We suggest that it may not have been a case of misdiagnosed eumycetoma but instead either eumycetoma developing at the site of excision of a nodule or the two conditions coexisting from the onset.

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Conflicts of interest

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1.	Kothiwala SK, Purohit S, Meena M, Jindal A. Black grain eumycetoma of the breast misdiagnosed as fibroadenoma. Indian J Dermatol Venereol Leprol 2015;81:521-3. [Google Scholar]
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