This 43-year-old woman from Mali in western Africa developed painful swelling in her left toe over 20 years ago following an injury from a thorn. Over several years the lesions pread to her ankle with subcutaneous nodules and draining sinuses involving most of her left foot. The foot became excritiatingly painful after even minor trauma. These findings were most consistent with mycetoma which is characterizec by the triad of tumefaction, draining sinuses, and the presence of grains in the exudate. Mycetoma occurs primarily in the tropics and the foot is most commonly involved producing the clinical picture of Madura foot. Mycetoma can be caused by true fungi (eumycetic mycetomas), filamentous bacteria of the order Actinmycetales (actinomycetic mycetoma), and other bacteria (botrymycosis). A skin biopsy for pathology and culture for fungi and bacterai are necessary to make a specific diagnosis and select appropriate antibacterial or antifungal therapy.
diffuse unilateral induration with subcutaneous nodules and sinus tracts