The 'Madura Hand'

Mycetoma or maduramycosis is a chronic deforming granulomatous musculoskeletal infection caused by bacteria (Actinomycetes sp) or fungi, most notably, Madurella mycetomatis. Approximately 70% of infections involve the foot, followed by hands. The diagnosis is suspected on the basis of a clinical triad of painless subcutaneous mass, multiple sinus tracts, and characteristic grain discharge. Histological examination of the discharge or biopsy is helpful for differentiating in between the causative organism. Imaging plays a crucial role in the management and prognostication of mycetoma by delineating the extent of involvement and exclusion of other chronic granulomatous infections, particularly in cases which lack classical clinical features. We report a case of eumycetoma involving the hand in a 50-year-old farmer. Both USG and MRI demonstrated intraosseous and soft-tissue lesions exhibiting the characteristic 'dot-in-circle' sign, which was diagnostic of the disease.