To the Editor.—
Certain points in the article by Drs Sindhuphal et al1 in the October 1985 Archives merit useful discussion: (1) The mycetoma had been active before the patient entered Texas. Where had the infection been contracted? Perhaps in Mexico, which is geographically a continuum with Texas? (2) Size, hardness and surface quality of the grains are not mentioned. The statement that "The biopsy specimen showed gram-positive, non-acid-fast granules with distinct borders" looks somewhat inaccurate, because gram staining is not suitable for granules but for actinomycetic hyphae. characteristic of a well-known entity, ie, the mycetoma by Streptomyces somaliensis, whose grains are hard-cemented and brittle, becoming fragmented when impacted by a microtome blade, then rolling up with the tissue section. The bodies seen in Figs 2 and 3 are mere residual parcels of grains in the breakdown process. In any case, some structures fixed by hematoxylin that are visible