Chaetomium atrobrunneum causing human eumycetoma: The first report

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In this communication, a case of black grain eumycetoma produced by the fungus C. atrobrunneum is reported.The patient was initially misdiagnosed with M. mycetomatis eumycetoma based on the grains' morphological and cytological features.However, further aerobic culture of the black grains generated a melanised fungus identified as C. atrobrunneum by conventional morphological methods and by internal transcribed spacer 2 (ITS2) ribosomal RNA gene sequencing.This is the first-ever report of C. atrobrunneum as a eumycetoma-causative organism of black grain eumycetoma.It is essential that the causative organism is identified to the species level, as this is important for proper patient management and to predict treatment outcome and prognosis. OverviewMycetoma is a chronic, progressive, granulomatous, subcutaneous inflammatory disease.It is caused by certain fungi and bacteria, and thus, it is classified as a eumycetoma and an actinomycetoma, respectively.More than 50 microorganisms were reported as mycetoma-causative organisms.Madurella mycetomatis is the most frequently reported eumycetoma-causative organism, with the highest worldwide disease burden.It generally affects children and young adults of low socioeconomic status, causing devastating deformities, disability, and high morbidity in late disease, and it has many severe effects on patients and communities.In this communication, we report on a 32-year-old patient from the White Nile state, Central Sudan.He presented with a painless subcutaneous swelling in the left foot of 7 years' duration.The clinical diagnosis was M. mycetomatis eumycetoma, for which he underwent wide surgical excision.The black grains' aerobic culture generated a melanised fungus identified as Chaetomium atrobrunneum by conventional morphological methods and by internal transcribed spacer 2 (ITS2) ribosomal RNA gene sequencing.The patient was started on empiric itraconazole, and fungal susceptibility was later confirmed by Sensititre YeastOne test (minimum inhibitory concentration [MIC] � 0.06).No evidence of recurrence was observed after 1 year of treatment.Our study adds C. atrobrunneum from the Sordariales order and Chaetomiaceae family to the list of melanised fungi causing human black grain eumycetoma.Both phenotypic and genetic methods were fundamental to elucidate the eumycetoma associated with this unusual mould and to determine the appropriate therapy.

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