Unusual Presentation of Eumycetoma (Madura Foot): A Case Report

Mycetoma, commonly referred to as Madura foot, is a chronic granulomatous infection of the skin and subcutaneous tissues caused by fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It typically presents in the foot following traumatic inoculation in endemic regions. Extra-pedal presentations are uncommon and may pose diagnostic and therapeutic challenges. We present the case of a 21-year-old previously healthy male patient with an unusual eumycetoma involving the posterior chest wall (back), an atypical anatomical site. The diagnosis was initially suspected clinically due to the discharge of black grains from the lesion and was subsequently confirmed by cytology, fungal culture, and molecular sequencing, which identified Madurella mycetomatis. This case highlights the importance of considering mycetoma in chronic, indolent subcutaneous lesions, particularly in endemic areas, even when lesions arise outside the commonly affected sites.