Unusual Presentation of Mycetoma of the Foot: A Rare Case Report

INTRODUCTION: Mycetoma is a chronic granulomatous infection. It is caused by actinomycetes or fungi. It is common in tropical countries and males. Predisposing conditions include malnutrition, poor hygiene, history of trauma, wounds on barefeet, and systemic infections. Eumycotic mycetoma commonly involves lower extremities whereas actinomycosis affects the cervicofacial, thoracic, and abdominal regions. Mycetoma presents with a chronic indurated ulcerated plague with swelling and yellowish discharge of sulfur granules. CASE REPORT: We report a rare case of a 40-year-old male with a left foot plantar swelling of 4 months duration with no discharging sinuses, fever, and pain. There was no history of trauma or barefoot walking. Clinical and magnetic resonance imaging (MRI) findings were suggestive of a soft-tissue malignancy. The mass was excised and sent for histopathology. Histopathology reported it as a mycetoma. Complete resolution was seen after 3 months of antifungal treatment and excision of the mass. This was unusual since there were no discharging sinuses, nodules, and even MRI reported as a fibrous or muscular mass. The diagnosis was made only after a histopathological examination. CONCLUSION: Mycetoma is a rare infection caused by fungal or bacterial organisms. In the absence of ulceration and sinuses, diagnosis can be difficult. Diagnosis requires a high degree of suspicion in the absence of such clinical signs. Definitive diagnosis should be made on histopathological examination. Once diagnosis is made, surgical excision with appropriate antifungals can result in complete cure without recurrence.