This 30 year old woman was evaluated for a chronic granulomatous ulcerated, exudative plaque on her leg. The lesion started several years earlier as a small progressive painless nodule. Skin biopsies with cultures for bacteria and fungi were pending. Although she complained of edema of the leg particularly after being on her feet all day, the large plaque did not interfere with her usuall activities. Mycetoma is a clinical diagnosis describing a chronic progressive granulomatous infection with confluent ulcerated papules, nodules, draining sinuses and fistulas with thick purulent drainage. The plaques are not painful and usually located on the foot, ankle or leg although any site can be affected. Lesions start by innoculation as small papules or nodules and progress over years. Mycetoma results from infection with a number of fungi and actinomyces most commonly Nocardia brasiliensis.
multiple ulcerated papules and nodules with overlying yellow exudate forming a large plaque