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Mycetoma. Presented by William M. Gould, MD.
The patient is a 65-year-old Filipino man employed as a grape picker in the San Joaquin Valley. About a year ago, he noticed a slightly painful "pimple" on the right foot. The lesion has continued to enlarge until its present size. The patient denies trauma to the area, but he has often worked in bare feet.Examination revealed a 3½ × 5¼ inch nodular plaque on the dorsomedial aspect of the right foot. There were scattered crusts on the surface with fluctuant, erythematous cysts. Removal of the crusts or puncture of cysts reveals a small amount of bloody pus which is quite thick. Pinpoint to pinhead sized black granules can be seen under some crusts and in the pus. The entire mass is fixed to the skin. There is a pruritic 2½ inch lichenified and slightly verrucous plaque on the right midpretibial area.
SAN FRANCISCO DERMATOLOGICAL SOCIETY. Arch Dermatol. 1966;94(2):249–251. doi:10.1001/archderm.1966.01600260141023
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