Calcaneal Osteomyelitis Caused by Exophiala jeanselmei in an Immunocompetent Child

Fungal osteomyelitis of the calcaneus is very rare and has been reported in immunocompromised children1,2. We present the case of an eight-year-old immunocompetent child with fungal osteomyelitis of the calcaneus from the fungus Exophiala jeanselmei, which has been reported to be a very rare cause of mycetoma pedis. To our knowledge, isolated involvement of the calcaneus with fungal osteomyelitis has not been reported previously. The family of our patient was informed that data concerning the case would be submitted for publication. Fig. 1 Clinical photograph showing multiple sinuses and granulation tissue involving the left heel. An eight-year-old boy presented with a six-month history of pain, swelling, and multiple discharging sinuses over the heel of the left foot. There was no history of trauma or skin puncture, but there had been intermittent discharge of black-colored granules from the sinuses along with an associated occasional low-grade fever. There were no systemic or constitutional symptoms otherwise. He had received treatment in the form of local dressings and broad-spectrum antibiotics from his primary care physician, but these treatments had had no appreciable effect. Fig. 2 Radiograph of the left heel, showing the honeycomb appearance of the extensive loculated lytic areas of destruction within the body of the calcaneus. Clinical examination of the left heel revealed discharging sinuses with black, soft, …