Pustules and sinus tracts involving the right arm of an elderly patient--quiz case. Diagnosis: eumycetoma.

The histopathologic findings from a pustule specimen from the right arm showed a dense dermal neutrophilic infiltrate consistent with an abscess (Figure 2). Grocott methenamine silver (GMS) staining was performed and showed a few small budding yeast fragments (Figure 3). There was no overt evidence of herpes virus infection. Tissue culture yielded Scedosporium species. The histopathologic features were consistent with a diagnosis of eumycetoma. The patient was treated with intravenous voriconazole, and in 4 weeks he had a marked decrease in limb girth, tenderness, and erythema with no signs of active infection.