Downloaded from www.microbiologyresearch.org by IP: 54.70.40.11 On: Sun, 25 Nov 2018 08:26:28 Case Report Cervical spinal cord compression: a rare and serious complication of Actinomadura pelletieri actinomycetoma Eshraga A. Ezaldeen, 1 Raif Mohamed Ahmed, 1 El Sammani Wadella, 1 Nadia El Dawi 2 and Ahmed Hassan Fahal 1 Correspondence Ahmed Hassan Fahal ahfahal@hotmail.com or ahfahal@uofk.edu 1 Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan 2 Department of Histopathology, Soba University Hospital, Khartoum, Sudan Introduction: Mycetoma is a chronic granulomatous inflammatory disease predominantly affecting the foot and hand. The cervical region is an uncommon site for mycetoma and spinal cord compression is a rare complication. Case presentation: This communication reports on a 40-year-old male farmer from Western Sudan who presented with quadriparesis due to cervical spine cord compression caused by Actinomadura pelletieri actinomycetoma. His condition started with a small painless subcutaneous swelling in the right shoulder region that gradually increased in size to involve the right side of the neck and the cervical spinal cord ending in progressive quadriparesis. He made a good response to an extended course of antibiotics, but was left with mild disability. Conclusions: A. pelletieri is an uncommon cause of actinomycetoma, and the clinical presentation of the reported patient is a rare and serious sequela of mycetoma. The literature contains only a very few reports on such presentation, and our case report will add to the knowledge and experience in managing such a presentation. Keywords: actinomycetoma; clinical presentation; complications; management; mycetoma; quadriparesis; spinal cord; Sudan. Received 6 October 2014 Accepted 20 June 2015 Introduction Mycetoma is a neglected tropical disease, which is endemic in many tropical and subtropical areas in what is known as the mycetoma belt (Fahal, 2004). It has devastating medi- cal and socio-economic impacts on patients and commu- nities in endemic areas (Fahal, 2011). The reported patient presented with quadriparesis due to cervical spinal cord compression caused by actinomycetoma, which is a serious and potentially fatal condition. Cervical actinomy- cetoma with cord compression is a rare sequela of myce- toma, and this case report intends to share experience and advance knowledge on the disease. Case presentation A 40-year-old male farmer from Western Sudan was referred to the Mycetoma Research Centre, Khartoum, Sudan with a history of bilateral upper and lower limb severe weakness rendering him immobile for 45 days. The weakness was gradual but progressive. Initially he developed right-sided weakness, progressing within a matter of a few days to involve the left side; he sub- sequently became bed-bound. He denied neither sensory nor sphincteric deficits. He had no change in vision, or dif- ficulty in swallowing or in breathing. There were no symp- toms suggestive of raised intracranial pressure or higher cortical function disturbances. Six years prior to presentation he noted a small painless right shoulder swelling. It progressively increased in size, and involved the right aspect of the neck and extended pos- teriorly towards the back of the neck. A localized dark dis- coloration of the skin over the swelling with multiple sinuses discharging red grains then developed. The patient could not recall a history of trauma at the swelling site. He initially presented to a district hospital where he received some medication for 2 months. There was a reduction in the size of the swelling; however, the patient was not aware of the diagnosis or medication given. He had no medical co-morbidities, no previous surgical intervention and he was not on regular medications. He is a farmer of low socio-economic status and there was no family history of mycetoma. Abbreviation: MRI, magnetic resonance imaging. JMM Case Reports (2015) DOI 10.1099/jmmcr.0.000074 G 2015 The Authors. Published by Society for General Microbiology This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/). 1