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
Borelli D, Middelveen M. Actinomycetoma Caused by Streptomyces somaliensis. Arch Dermatol. 1986;122(10):1097–1098. doi:10.1001/archderm.1986.01660220011002
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