Eumycetoma caused by Madurella fahalii, a drug-resistant fungus, has never been reported in India. Here, we describe a fatal case of eumycetoma with spinal involvement due to M. fahalii for the first time in India.

Eumycetomas of craniocerebral are rare, and we report an extraordinary case of maduramycosis involving brain and skull bone in a middle-aged male who presented with complaints of headache, behavioral abnormalities, and memory disturbances for 3 months. Imaging showed a frontal lesion. It was mistaken for a tumor clinically and radiologically. Craniocerebral eumycetoma usually presents as a mass on the scalp with sinuses. Our case presented as a brain tumor without a soft tissue mass or discharging sinuses. It is essential to keep in mind this mode of presentation, and only a biopsy will aid in diagnosis.

Mycetoma or Maduramycosis is a localized chronic suppurative infection characterized by exuberant granulation tissue, discharging sinuses, and bone involvement later in the course of the disease. Early clinical diagnosis before the appearance of sinuses and grains (aggregates of organism surrounded by granulation tissue, which are discharged from the draining sinuses) is difficult. Delay in diagnosis may lead to amputation of the affected part. Definitive diagnosis is through biopsy and microbiological examination. However, at times diagnosis may still be difficult. The recently described \"dot in circle\" sign on magnetic resonance imaging (MRI) is easy to recognize and highly specific. We present a case of mycetoma foot with characteristic MRI features.