It is popularly believed that
eumycetoma cases should be dealt with using
surgical amputation for a better chance of cure especially when
chemotherapy has failed. However,
amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the
eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal
therapy and refused below-knee
amputation 12 years ago. With counseling and
wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after
amputation. Another 46-year-old female underwent below-knee
amputation after receiving incomplete courses of
antibiotics and antifungals for
mycetoma of unknown etiology. She presented to us after recurrence of
mycetoma on an amputated stump and was successfully treated by proper courses of
antibiotics after detecting the causal agent, Actinomadura madurae. Her post-
amputation disability and depression could have been avoided if the hasty decision of
amputation had not been taken. In our opinion, living with
drug-non-responsive
mycetoma, supported by symptomatic management, may be a better option than
amputation and its associated morbidities. So before taking the path of salvage
amputation, we must consider many aspects, including patient's livelihood, psychological aspects and chances of recurrence even after the procedure.