Recurrent hemorrhagic myospherulosis of the popliteal fossa: A 30-year unrecognized case with implications of fungal involvement

Abstract

Myospherulosis is a rare and poorly understood condition. The condition is initially suspected based on imaging findings, with confirmation requiring anatomopathological analysis. This lesion was first described in the United States in 1977, identified as spherules present in the anterior surgical regions of the nose, paranasal sinuses, and middle ear. The initial hypothesis proposed an infection by an unidentified endo-purulent fungus infection, perhaps due to the use of gauze soaked in antibiotics and non-sterile Vaseline. It was later suggested that these spherules were more likely altered red blood cells affected by lipid substances, leading to a granulomatous inflammatory reaction of the foreign-body type. We present the case of a 60-year-old patient with recurrent small subcutaneous nodules appearing in flare-ups since 2004. These painful purplish nodules evolved into ulcerations and bleeding. The lesions were accompanied by pain and functional weakness of the lower limb, that healed spontaneously. A long remission was reported after the prescription of antifungal treatment, which suggesting that an endosporulating fungal infection may have played a role in the pathophysiology of this lesion, alongside other contributing risk factors. Therefore, initiating antifungal therapy before surgical intervention may help improve the patient's prognosis.