Vol. 7, Issue 2, Part H (2025)

Mycetoma is a persistent granulomatous infection produced by filamentous fungi (eumycetoma) or aerobic bacteria (actinomycetoma), and effective treatment depends on differentiation between the two. Here we report a case of a male farmer from rural South India who developed ulceration, swelling, and multiple discharging sinuses from his right foot. After an initial diagnosis of eumycetoma based on the potassium hydroxide (KOH) mount, itraconazole treatment was initiated. However, recurrence within a month required additional evaluation. Actinomycetoma was confirmed by repeat histopathology, which showed basophilic filamentous sulphur granules with PAS-positive organisms. Significant clinical improvement was achieved when the patient received treatment with amikacin, cotrimoxazole, and rifampicin. This case emphasizes the challenge in diagnosing mycetoma and the importance of demonstrating a correlation between histopathological, microbiological, and clinical findings. To prevent misdiagnosis, repeated biopsy, culture and if feasible molecular testing should be carried out in situations that are recurring or non-responding.