P209 First report of Mycetoma due to Madurella fahalii from India

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVE: To describe the first case report of Madurella fahalii from India. METHODS: A 70-year-old non-diabetic man from Bhadrak Odisha who worked as a soldier in past came to us with a history of pus discharge containing black grains the size of mustard seeds from multiple sinuses in the posterior aspect of the thigh for last 5 years. He had been operated 2 years back for the same complaints, however, finding no relief he visited us. On examination, a depressed lesion measuring 10 × 10 cm, containing 6-8 sinuses which discharged pinkish yellow colored pus containing black grains measuring 0.5 × 1 cm was found on the posterior aspect of the thigh. The lesion was painless, doughy in consistency, and associated with enlarged and non-matted and non-tender inguinal lymph nodes measuring 2 × 2 cms. General physical examination and routine hematological laboratory examination revealed no abnormalities. Serological tests did not reveal the presence of HIV, Hepatitis B, or Hepatitis C infection. A clinical diagnosis of black grain mycetoma was made and the patient was sent to mycology laboratory for fungal culture. Black hard grains were found on KOH mount and culture on inhibitory mold agar grew a brown colony which diffused a brown pigment into the medium after 15 days of incubation. LPCB examination showed brown non-sporulating mold. DNA was extracted using phenol-chloroform isoamyl alcohol after grinding the mycelial mat in liquid nitrogen and subjected to PCR using ITS4 and ITS5 primers as described previously. The product was subjected to sanger sequencing and subjected to blast and it showed 99.45% similarity to M. fahalii (MF980633). The patient was started on Itraconazole in lieu of voriconazole as the patient could not afford the drug. While there is no reduction in the size of the lesion the patient reported symptomatic relief and is still on follow-up. CONCLUSION: To the best of our knowledge this is the first case of Mycetoma due to M. fahalii from India.