Mycetoma, a chronic subcutaneous infection caused by bacterial or fungal species from soil and water, presents a diagnostic challenge due to its rarity and diverse clinical manifestations. Predominantly affecting male workers in endemic regions, mycetoma typically manifests as painless swelling evolving into purulent lesions with draining sinuses in the extremities. Although historically uncommon in regions like North America, rising immigration and international travel have led to an increased prevalence, necessitating heightened clinical suspicion. Early diagnosis is crucial to prevent severe complications such as limb loss and septicemia. This case report details the diagnosis and management of chronic actinomycetoma due to Nocardia spp. in a Guatemalan immigrant landscaper and emphasizes the importance of comprehensive understanding and timely intervention in mycetoma cases.

Mycetoma is a suppurative chronic bacterial or fungal disease inoculated into the body by minor trauma which may penetrate from subcutaneous tissue to bone. Although the lower extremities are most commonly affected, rare forms can also be seen from time to time. The diagnostic triad of swelling in the affected area, multiple sinus formation, and purulent discharge with grains are typical. Definitive diagnosis is made by isolation of the causative pathogen, radiologic imaging, and histopathologic examination. Antifungal and antibacterial options are applied together with surgery. Our aim in this case series is to report and analyze 10 rare cases of mycetoma.

UNASSIGNED: Actinmomycetma is a granulomatous infection with a presentation was very similar to osteosarccoma. Multidisciplinary team and triple assessments are extremely important to prevent misdiagnosis, surgical treatment in combination with medical treatment followed by regular clinical and radiological follow-up can be a limb-saving procedure in such cases.
UNASSIGNED: Various conditions may mimic osteosarcoma. The differential diagnosis of osteosarcoma is broad; Includes tumors, infection, trauma, and inflammatory processes arising from the musculoskeletal system. A proper history, examination, diagnostic imaging studies, and pathological analysis are essential to establish a precise diagnosis. This case report serves to illustrate the significance of recognizing the similarities between these two lesions and other rare features that will help to differentiate between actinomycetoma and osteosarcoma, to prevent late or misdiagnosis.

UNASSIGNED: Neoplasms of the Kidney are rarely caused by actinomycetoma or other mycetoma species. Actinomycetoma is a neglected tropical disease which is not uncommon in Sudan. Usually, it is presented as skin and subcutaneous tissue lesions or mass and can affect the bone and other soft tissue. Sites of the lesion are found in lower limbs, upper limbs, head and neck and torso.
METHODS: A 55-year-old female presented incidental left renal mass on ultrasound examination from the internal medical department. It is presented as a renal mass mimicking renal cell carcinoma with coexistence with another actinomycetoma brain mass. The histopathology report after nephrectomy confirmed the diagnosis. Patients commenced on anti-actinomycetoma treatment after nephrectomy.
UNASSIGNED: This is the first reported case in our facility which was diagnosed as a renal actinomycetoma. It was treated by surgical excision and received antibacterial treatments.
CONCLUSIONS: This case demonstrates that renal actinomycetoma can occur in an endemic area even without cutaneous or subcutaneous lesions.

Mycetoma is a chronic discharging infection involving the skin, subcutaneous tissue, fascia, and bone, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma localized on the foot of a patient living in a country with a temperate climate. A 32-year-old male patient presented with painless swelling in the right foot. He had undergone surgery 3 years ago with the same complaints. Magnetic resonance imaging revealed a 90 × 65 × 37 mm cystic soft tissue lesion in the posterior of the right ankle. Histological analysis identified the fungus. Extensive resection was performed. Mycetoma is characterized by chronic granulomatous inflammatory response, often associated with sinus tract formations due to fungal (eumycetoma) or bacterial (actinomycetoma) organisms. Here we provide a literature review and highlight the importance of increasing awareness toward mycetoma, particularly in non-endemic regions.

Mycetoma, well known as \"Madura foot,\" is a long-standing granulomatous infection of the skin and subcutaneous tissue. Causative organisms are filamentous fungi (eumycetes) and bacteria (actinomycetes). It characteristically presents with firm woody swelling, discharging sinuses with grains (containing the causative organism). Diagnosis in suspected cases can be made by microbiological evaluation, histopathological, cytological and radio imaging techniques. To differentiate between eumycetoma and actinomycetes histopathology is an accurate diagnostic modality as seen in the present case. We report a case of 42 years male who presented with swelling on his back with discharging sinus. Histopathological specimen containing multiple, irregular, greyish, whitish tissue pieces with skin attached all together measuring around 12×9×4 cm from the paraspinal region. The section shows histopathological features suggestive of eumycetoma. Periodic acid -Schiff stain showed the presence of septate, branching fungal hyphae and black granules. Eumycetoma can be accurately diagnosed by histopathological evaluation using a special stain. It is confirmatory and provides a guide for treatment plans with a high index of suspicion.

BACKGROUND: Mycetoma is a neglected tropical disease that commonly affects the lower extremity. The disease is attributed to subcutaneous granulomatous inflammation leading to distinct clinical features of gradual painless swelling accompanied by nodules and drains. Orbital mycetoma is an extremely rare entity of the disease. We reported the clinical presentation, diagnosis, and surgical outcomes in a case of orbital mycetoma with cranial extension.
METHODS: A 25-years-old male complained of left eye protrusion for 8 years, followed by complete loss of vision on the left eye for 7 years and eventually left eye pain for the last year. The left eye was displaced anteriorly and inferiorly with normal oculomotor, abducent, and trochlear examination. Brain CT scan showed an increase in orbital bone thickness with extension to the anterior cranial base, middle cranial base, and the orbital process of the zygomatic bone. MRI revealed a large lesion involving the left frontotemporal region with extension to left orbit, left posterior ethmoid air cells, and left temporal suprasellar region. The lesion was homogenously enhanced with contrast. The patient underwent a left orbitozygomatic cranitomy for resection of the lesion. However, total resection was inapplicable due to the extension of the bony lesion up to the petrous bone. Cranioplasty was performed by titanium mesh.
CONCLUSIONS: Mycetoma is a chronic inflammatory disease affecting subcutaneous tissues commonly in the lower limbs. The disease can be caused by fungi (Eumycetoma) or bacteria (Actinomycetoma). Orbital mycetoma is an extremely rare entity of the disease. However, it is commonly associated with the cranial extension. Early diagnosis and prompt surgical and medical treatment are the keys to good outcomes.

Mycetoma is a chronic granulomatous infection caused by fungi or bacteria, known as eumycetoma and actinomycetoma, respectively. Mycetoma commonly affects young males belonging to low socioeconomic strata, usually barefooted agricultural workers. It mainly affects lower and upper limbs presenting as a painless swelling with discharging sinus. Rarely, is it encountered in the intracranial location. The diagnosis relies on the clinical presentation and identification of the etiological agents within the tissue, by histology and special stains. It is important to specify the fungal or bacterial etiology, because the treatment of each is completely different. The management of such infections is challenging and should involve early diagnosis, the use of antibacterials or antifungals, and surgical removal of the lesion. To the best of our knowledge, only seven cases of intracranial mycetoma have been reported. The present case highlights the rarity of this lesion, thereby contributing to the existing literature and presenting its diagnostic implications.

UNASSIGNED: Abdominal actinomycetoma is a rare and often a missed diagnosis by most of clinicians due to its rarity and different clinical presentations. It is caused by Actinomyces speces which are gram positive bacilli and normal commensal inhabitants of the human bronchial and gastrointestinal tracts. A.Israelli is responsible for disease in humans once the mucosal barrier is broken.
METHODS: This case report presents an adult female patient who consulted for a localized abdominal wall mass of 3 weeks duration and the clinical exam was in favor of an abdominal wall abscess, but later found to be an actinomycotoma of the colon invading the abdominal wall and forming an abdominal wall abscess. Transverse colectomy and drainage of abscess was done and she improved well.
UNASSIGNED: Actinomycosis is common in the tropical and subtropical area. However, this is the first case reported in Rwanda and prompt surgical treatment and antibiotherapy have led to a good clinical outcome.
CONCLUSIONS: Abdominal actinomycetoma should be considered as a differential diagnosis of any abdominal wall mass for patients with known risk factors and surgery and antibiotics are the only curative treatment.

BACKGROUND: Mycetoma is a chronic granulomatous subcutaneous infection caused by anaerobic pseudofilamentous bacteria or fungi. It is commonly prevalent in tropical and subtropical countries. Men are more susceptible to the disease due to greater participation in agricultural works. Mycetoma commonly involves lower extremities, wherein untreated cases lead to aggressive therapeutic choices, such as amputation of the affected body organs and consequently lifelong disability.
METHODS: In this report, we present the rare case of a 58-year-old man, originally from Algeria with a left foot chronic tumefaction of 5 years. In the initial clinical examination, mycetoma was diagnosed based on tumefaction and the presence of multiple sinuses with the emission of white grains. The latter was observed via direct examination. The histopathological analysis demonstrated an actinomycetoma caused by bacteria, as the etiological agent. Imaging showed a bone involvement with osteolysis at the levels of 2nd to 4th metatarsal diaphysis. The mycological and bacterial cultures were both negative. For an accurate diagnosis, the obtained grains were subjected to molecular analysis, targeting the 16S-rDNA gene. Molecular identification yielded Actinomadura madurae as the causal agent, and 800/160 mg of trimethoprim/sulfamethoxazole was prescribed twice a day for 1 year, as a treatment.
CONCLUSIONS: Considering low information about this disease, especially in non-endemic areas, it is of high importance to enhance the knowledge and awareness of clinicians and healthcare providers, in particular in the countries with immigration issues.