Eumycetoma with pulmonary dissemination an unusual complication: Case series and literature review

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Case presentation Case No. 1The patient was a 30-year-old jobless female from Sennar State, Central Sudan.In 2005, she stumbled during walking without obvious injury, which was followed by the appearance of a small painless swelling in the right big toe that rapidly increased in size.She consulted a traditional healer, and multiple skin incisions were done without improvement.Then, she consulted a local health center where an anti-tetanus toxoid injection was given, and her condition got worse, and she ended with a right big toe amputation 20 days later.Fifteen days following that, she noticed a painful swelling in her popliteal region that gradually increased in size.In 2008, multiple sinuses appeared on the swelling and started to discharge black grains.She was referred to the Mycetoma Research Center (MRC), Khartoum, for further management.She had a surgical biopsy that revealed evidence of Madurella mycetomatis eumycetoma, and she was started on 400 mg itraconazole daily and 5 mg folic acid daily.In 2009, she had wide local surgical excision of the mass.However, she stopped treatment as she assumed she was cured.The popliteal swelling recurred in 2012 at the surgical scar, and it rapidly progressed in size to affect the whole area and multiple sinuses discharging blood, and black grain appeared.She did not seek medical advice till 2015 when she was seen at the MRC.In 2019, she developed a dry cough, not responding to medication.In February 2020, the cough became productive with blood that increased intensity and frequency.Her condition progressed, and in 2021, she developed central chest pain, which was dull, crashing in nature, and was associated with shortness of breath and palpitations.Three months later, she experienced lower right chest side sharp pain aggravated by coughing and movement more during the night, which was relieved by analgesics.She had daily low-grade pyrexia for more than 3 years, more aggravated at night.In March 2021, the cough became painful and forceful, containing black grains.The cough increased in frequency and interfered badly with her sleep.The coughed black grains increased in amount gradually.She developed a poor appetite, fatigability, headache, and joints pain and became depressed, which had a negative psychosocial impact on her and her family.On clinical examination, the patient looked depressed, emaciated, and wasted.She was not pale, neither jaundiced nor cyanosed.Head and neck examination was within normal.The respiratory system examination showed normal chest skin, the right side was moving less, tactile vocal resonance was more on the right side, percussion note was dull on the right lower

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