A mycetome may occasionally involve the perineum. This may be due to a fungus (eumycetoma) or filamentous bacteria (Nocardia or Actinomycete, actinomycetoma).
Clinical features:
(1) mass lesion involving the groin, perineum and/or genitals
(2) multiple draining sinuses
(3) presence of granules in the discharge with the Splendore-Hoeppli reaction
(4) variable history of trauma or environmental contact
(5) MRI can be helpful in determining the extent of disease
The color of the granules can be helpful in suggesting the causative organism.
Differential diagnosis:
(1) lymphogranuloma venereum (LGV)
(2) tuberculosis
(3) botryomycosis
(4) cutaneous leishmaniasis
(5) syphilis
(6) abscess
(7) osteomyelitis
(8) carcinoma
(9) deep fungal infection
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