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

Sofia El Haitamy, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Zakia Douhi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Aimane Zaim, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Meryem Soughi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Sara Elloudi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Hanane Baybay, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Fatima Zahrae-Mernissi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco

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.

Keywords: Actinomycetoma. Combined therapy. Madura foot. Morocco. Mycetoma. Non-endemic area.