Scintigraphic evaluation of mycetoma.

Mycetoma is a rare deep mycosis caused by certain fungi. Clinical findings include enlargement and tumefaction of the affected region accompanied by grains coming out of the lesions. The feet are the most frequently affected area. Four patients have been studied who presented with mycetoma of the feet. Gallium scintigraphy was always abnormal in the affected areas and bone scintigraphy was abnormal in three of the four patients. The patient who had a normal bone study had received effective treatment (7 years). In the other patients the results were poor. Scintigraphic findings seem to be similar to those noted in cases of acute osteomyelitis associated with cellulitis, despite long-term therapy. Bone and gallium studies may be of possible value for therapy follow-up in cases of mycetoma.

[Black-grain eumycetoma due to Madurella grisea. A report of 2 cases]. / Eumicetoma de grãos pretos por Madurella grisea. Registro de dois casos.

Two cases of black grains eumycotic mycetoma, occurring on a foot, are reported. Both proceeded from the state of Bahia (Brazil), and in both the etiologic agent was Madurella grisea Mackinnon et al., 1949. The grains structure as well as the micromorphologic characteristics of the fungus in saprophytic life were studied. It is the author's belief that these observations correspond to the 7th and 8th cases reported in the Brazilian medical literature. The authors do consider the following Madurella species as nomen dubium or nomina confusa: M. ramiroi, M. oswaldoi, M. bovoi, M. tozeuri, M. mansonii, M. brumpti, M. reynieri, M. americana, M. lackawanna e M. ikedae and the same for Rubromadurella mycetomi. The only valid species must be Madurella mycetomatis McGinnis, 1980 (= Madurella mycetomi Brumpt, 1905) and Madurella grisea Mackinnon et al., 1949. Treatment with itraconazole in both reported cases, for a 3 month duration, did not produce any regression of the lesions, the clinical improvement being meager.

[2 infectious granulomatous diseases (leprosy and cutaneous and mucous leishmaniasis) by scintigraphic methods]. / Contribution au début de l'étude de deux maladies infectieuses granulomateuses (la lèpre et la leishmaniose cutanée et muqueuse) par des méthodes scintigraphiques.

Leprosy is a multiform chronic infectious granulomatous disease caused by Mycobacterium leprae, that affects over 12 million people in the world. Cutaneous and mucous leishmaniasis (CML) is also a chronic granulomatous infectious disease, caused by Leishmania brasiliensis and transmitted to man by the mosquitoes of the Phlebotominae family. It is a worldwide spread disease. We studied one case of Borderline-wirchowian leprosy and 2 cases of CML with Gallium-67 (GA-67) scintigraphy. Ga-67 is a radiopharmaceutical known for its property of concentrating in inflammatory sites. In the leprosy patient, Ga-67 accumulated in the skin in a moderate, homogeneous and disseminated way (outlined skin); in the area of the face, the uptake was important and homogeneous (image in beard). Several internal organs accumulated Ga-67. As for the 2 CML patients, Ga-67 accumulated focally, in different degrees, in the affected anatomical areas. The leprosy patient was not under treatment and the 2 CML were under treatment (20 and 40 days, respectively). In the 3 cases, all affected areas accumulated Ga-67. Intensity differences of uptake may be explained both by different degrees of inflammatory processes (between leprosy and CML) and by treatment lasting. It is possible that Ga-67 scintigraphy may be useful for the evaluation of these 2 diseases extent and also for the therapy follow-up.

[Keloid paracoccidioidomycosis assessed with gallium]. / La paracoccidioidomycose chéloïde étudiée avec le gallium.

This rare mycosis is caused by Paracoccidiodis loboii and is found mainly among indians of the Amazon forest. It is a cutaneous disease. No visceral affection was ever described, though generalized skin disease has been reported. One case of cheloid paracoccidioidomycosis was studied with gallium-67. The radiopharmaceutical has accumulated in the affected area and in a lymph node, although adenomegaly be rare. Degree of accumulation was discrete/moderate but the patient had been under irregular treatment for 10 years. As no laboratorial data are evaluable for this affection, gallium-67 may represent a means of disease extent and therapy efficacy evaluation.

Gallium scintigraphy in Hansen's disease.

Gallium 67 imaging was used in 12 patients with documented Hansen's disease undergoing treatment or not, in an attempt to determine the pattern of the disease. Diagnosis was confirmed by histopathology in all patients. The Mitsuda reaction was seen in all patients. Specific nuclear studies were performed when needed to evaluate particular organs better. Gallium 67 images show homogeneous, diffuse and moderate accumulation over the entire skin surface (except for the face) of untreated patients with multibacillary disease. The facial skin in these cases presented homogeneous, diffuse but very marked uptake of gallium. Internal organ involvement was variable. There was a very good correlation among clinical, scintigraphic, immunological and histopathological data. The pattern of the body skin ("skin outlining") and facial skin ("beard distribution") may be distinct for untreated patients with multibacillary leprosy.