Mycetoma foot
A 60-year-old male living in a village about 90 km from Pune presented to our hospital with a history of generalized swelling of the left foot of about 11 months’ duration. The initial lesion had started as a single nodule over the dorsum of the foot and was followed by a second nodule that appeared two months later and a few more nodules subsequently. These lesions, mainly distributed over the dorsum of the foot [], then burst to develop sinuses from which there was intermittent discharge of yellow colored granules. Over a period of three months, the patient developed pain in the foot that made walking difficult The left foot was grossly swollen to the ankle with healed sinuses. The clinical findings at this point were suggestive of mycetoma.\nOsteomyelitic changes involving the left calcaneum were seen. Since there was no discharging sinus at the time of presentation, biopsy was done from the site under ultrasound guidance and the specimen sent for staining and culture. Non-acid fast gram-positive narrow filamentous branching bacilli were seen [Figures and ]. Culture in plain Sabourauds’ dextrose agar showed growths of Nocardia species.\nThe patient was started on Trimethoprim-sulphamethoxazole (14 mg/kg, twice daily) along with Dapsone (1.5 mg/kg, twice daily) and Rifampicin (600 mg/day). The swelling decreased in size following surgical debridement of one large painful nodule. The patient has been followed up for a period of three months so far and the medication will be continued for a total period of six months or until cure is achieved.