Surgical Management and Antifungal Therapy for Extensive Eumycetoma of the Right Foot: A Case Report from Resource Limited Settings

Abstract

Introduction: Mycetoma is a neglected tropical disease characterized by chronic granulomatous infection of the subcutaneous tissues. It is classified etiologically into actinomycetoma (bacterial) and eumycetoma (fungal). Differentiation is vital as the management protocols differ significantly. Case Presentation: We report the case of a 25-year-old male from the Hiran region of Somalia who presented with a four-year history of a recurrent, discharging lesion on the right calcaneus. Magnetic Resonance Imaging (MRI) revealed the pathognomonic "dot-in-circle" sign. Intraoperative assessment revealed necrotic tissue containing characteristic black grains. Histopathological examination confirmed the presence of compact fungal grains composed of septate branching hyphae, establishing a diagnosis of eumycetoma. Conclusion: The patient was successfully treated with wide surgical debridement combined with adjuvant Itraconazole therapy. This case emphasizes the importance of histopathology and clinical grain characteristics in diagnosing fungal mycetoma in endemic regions.