This 45-year-old farm worker presented developed a wound on the medial aspect of his left foot caused by cactus thorn while working in the field about 25 years ago. Unfortunately, the wound was treated by his father with a home remedy, the application of a donkey feces over the wound for several days. Multiple abcesses and nodules associated with edema formed over the affected area and gradually spread to the rest of his left foot and lower leg. There were no draining abcesses and fistulae, but the patient had to frequently drain the subcutaneous abcesses with a a shaving blade to reduce the pain. Thick purulant granular fluid was drained from the medial aspect of his foot and sent for microscopic examination and bacterial culture. Mycetoma is a chronic, granulomatous disease of the skin and subcutaneous tissue, which sometimes involves muscle, bones and neighboring organs. Fungal and/or bacterial organisms can trigger the chronic granulomatous reaction.
diffuse edema, scaling, and thickening of the skin with multiple clustered warty nodules and abcesses