Cervicofacial Actinomycetoma Presenting with Black Grain: A Rare Clinical Scenario.

Mycetoma is a chronic skin and subcutaneous tissue infection characterized by a triad of localized swelling, draining sinuses, and grains or granules (composed of aggregations of the causative organism) within the sinus tracts. It is caused by filamentous higher bacteria (known as actinomycetoma) or fungus (known as eumycetoma). Usually actinomycetoma presents with white-yellow grains and majority of eumycetoma causes black grains. However, actinomycetoma caused by Streptomyces sp. produces large brown-black grain, which is often misdiagnosed as eumycetoma, therefore confirmation by culture is necessary. Here, we present a case of 28-year-old female presenting with typical features of mycetoma at cervicofacial region. On direct microscopy (40×) with potassium hydroxide (KOH) mount of discharge released from sinuses showed large and black grains, initially raising a suspicion of eumycetoma, but later, it was confirmed by culture as actinomycetoma caused by Streptomyces sp. Patient is now symptomatically better on treatment. Production of black grain by actinomycetoma is a rare clinical scenario.

Squamous Cell Carcinoma Arising in Chronic Osteomyelitis: A Rare Presentation.

BACKGROUND: Malignant transformation of chronic osteomyelitis is extremely rare. Squamous cell carcinoma (SCC) is the most frequently reported malignancy, with a latency period of 20-50 years after the onset of osteomyelitis. CASE PRESENTATION: A 61-year-old man presented with recurrent discharge from the left distal thigh 30 years after open femur fracture. Histopathology showed SCC arising from chronic osteomyelitis with bone invasion. The patient initially declined amputation but eventually consented to transfemoral amputation after symptom recurrence. TREATMENT AND OUTCOME: Intraoperative frozen section was utilized to determine the level of amputation. CONCLUSIONS: This case highlights the importance of definitive surgical treatment with amputation for SCC arising in chronic osteomyelitis, even after initial patient refusal. Recurrence should prompt the reconsideration of amputation.