Madura foot - mind the soil

'Madura foot' or mycetoma is a chronic granulomatous soft-tissue infection, caused by either true fungi (eumycetoma) or Gram-positive aerobic bacteria (actinomycetoma). The infection is endemic to equatorial, tropical or sub-tropical regions. However, sporadic cases have been reported in the Western world mostly in the migrant population. The disease follows a slow progression from the time of traumatic inoculation to presentation of symptoms, characterised by a triad of chronic indurated swelling, draining sinuses and discharging granules. The granules are diagnostic as they represent collections of fungal hyphae or bacterial filaments. We present a case of a 4-year eumycetoma of the left foot in a 16-year-old Somalian girl, resident in the UK for over a year. She underwent aggressive surgical debridement with a 6-month course of anti-fungal medication. We emphasise the need for suspicion of this rare dermatosis, in view of the increasing immigrant population.