Mycetoma beyond borders: actinomycetoma in a non-endemic setting: a case report

Mycetoma is a chronic granulomatous infection mainly affecting skin and subcutaneous tissues, most commonly the foot in young adult males from tropical/subtropical rural areas. Caused by actinomycetoma or eumycetoma, it presents with progressive painless swelling, multiple sinuses, and colored-grain discharge. While endemic in the “mycetoma belt,” sporadic cases occur in non-endemic regions, including Morocco, where delayed diagnosis often leads to severe deformity and amputation risk. We report a 34-year-old Moroccan man with a 2-year history of right foot swelling, fistulas, and yellowish-white grains following a splinter injury. Actinomycetoma due to Actinomadura spp. was confirmed by histopathology and culture. Extensive surgical debridement combined with prolonged triple antibiotic therapy (trimethoprim-sulfamethoxazole, amoxicillin-clavulanic acid, amikacin) achieved complete healing and no recurrence at 12 months despite osseous involvement. This case highlights the importance of considering mycetoma in chronic foot lesions in non-endemic areas and the efficacy of early combined treatment to prevent disabling sequelae.