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Mycetoma, commonly known as Madura foot, is a chronic and progressively destructive granulomatous disease caused by a fungus or anaerobic filamentous bacteria that affects the skin, subcutaneous tissue, and bones primarily in tropical and subtropical regions, with males between the ages of 20-40 having occupational exposure to outdoor environments, such as farming, predominantly affected. It is one of the World Health Organization's 17 ''neglected tropical diseases,'' characterized by a clinical trial of localized mass-like soft tissue injury with draining sinuses that discharge grains of infectious material. Here, we present a case report of a 40-year-old male with type 2 diabetes mellitus and a history of fieldwork, who exhibited early manifestations of mycetoma. Unlike the typical diffuse presentation seen in advanced cases, this patient's early presentation prompted diagnostic challenges due to its atypical nature. We highlight the importance of recognizing the early signs of mycetoma, particularly in individuals with predisposing factors such as diabetes and occupational exposure. Diagnostic dilemmas may arise, leading to potential misdiagnosis. Additionally, we emphasize the crucial role of biopsy in confirming the diagnosis, alongside imaging techniques, to facilitate timely intervention and management, thereby significantly impacting patient outcomes.

The case presented illustrates a very rare chronic granulomatous disease called the Madura foot or also called mycetoma. It is a chronic granulomatous disease, caused by a contained infection that penetrates the subcutaneous tissues and spreads to the nearby bone by damaging the affected area's vascularization. Early diagnosis is greatly aided by clinical history and imaging, especially if the “dot-in-circle” sign—a pathognomonic marker of mycetoma—is seen on the MRI. Compared to ordinary radiographs, computed tomography offers a more accurate study of changes in the bone. In order to apply the appropriate course of treatment, it is critical to identify the causal species, which can be caused by either a true fungus (eumycetoma) or a bacterium Actinomyces (Actinomycetoma). Treatment can be extremely challenging and can even result in amputation, particularly if the diagnosis is delayed.

Key Clinical Message: This case report explores the clinical journey of a patient initially diagnosed with botryomycosis, only to later reveal the underlying and rare condition of actinomycosis. The report highlights the challenges in getting to an accurate diagnosis, emphasizing the importance of considering uncommon pathologies, the utility of multi‐disciplinary teams and clinico‐pathologic correlation in clinical practice. [ABSTRACT FROM AUTHOR]

Key Clinical Message This case report explores the clinical journey of a patient initially diagnosed with botryomycosis, only to later reveal the underlying and rare condition of actinomycosis. The report highlights the challenges in getting to an accurate diagnosis, emphasizing the importance of considering uncommon pathologies, the utility of multi‐disciplinary teams and clinico‐pathologic correlation in clinical practice.

Mycetoma or Madura's foot is a rare condition in Morocco. It is a chronic infection that affects deep subcutaneous tissues and may eventually spread to deep tissues, muscles, and bones. It is caused by fungi or bacteria and most often affects the foot. Biopsy and microbiological examination help to establish a definitive diagnosis, but may delay it. Imaging plays a crucial role in early diagnosis, particularly MRI findings that show a pathognomonic sign of mycetoma which is the dot-in-the-circle sign. Computed tomography provides a better analysis of bone changes than plain radiography. Treatment is very difficult, especially if the diagnosis is delayed, and may even lead to amputation. We present here a case of mycetoma of the foot with some MRI features.

Madura foot is a chronic, progressively destructive bacterial or fungal infection of the subcutaneous tissues, which may affect skin, muscle, and bone. It is endemic in tropical and subtropical areas known as the "Mycetoma belt" between latitude 30°N and 15°S. Mycetoma is prevalent in the poor population living in remote areas of developing countries that lack proper reporting system and management. The World Health Organization recognized mycetoma as a neglected tropical disease back in 2016. Though the diagnosis is challenging, early detection and proper treatment can reduce morbidity and provide a promising outcome. We report a case of chronic painless, multiple papulo-nodular skin lesions at the foot that resembles mycetoma infection which was detected early and recovered with a satisfactory outcome with proper treatment. [ABSTRACT FROM AUTHOR]

Background: Mycetoma also synonymous referred to as Madura's foot is a chronic granulomatous cutaneous infection caused by some genera of fungi and bacteria, leading to progressive and proliferative destruction of soft tissue and the nearby anatomical structures if no intervention is offered on time. Case presentation: We report a case of actinomycetoma in an African adult man residing in a rural-urban setup. After histological confirmation, the client was conservatively managed with oral medication: 1) dapsone 100mg once a day and t r ime thopr im/sul f ame thoxa zol e (s ept r in) 160mg/800mg three times daily for one year with an excellent outcome. Conclusions: The gist of this rare case is to exemplify the role of integrated management of patients without underplaying the role of good clinical practice. Also, a call and advocate for improved health care services in the sub-Saharan countries. This will prevent or reduce avoidable medical complications caused by neglected and treatable diseases like actinomycocetoma. [ABSTRACT FROM AUTHOR]

Madura foot is a chronic granulomatous disease of the skin and underlying tissues caused by fungi or bacteria. Early diagnosis is important to avoid disfiguring limb deformities. Low clinical suspicion, limited availability of diagnostic tools, and infection with fastidious organisms may lead to misdiagnosis and delayed treatment. Imaging tests can help to make a timely diagnosis in a non-invasive manner. Here we report two patients with a non-classical clinical presentation and a more favorable differential diagnoses who were correctly diagnosed as cases of Madura foot based on the ‘‘dot-in-circle sign’’, a specific finding on magnetic resonance imaging and ultrasound.

The case presented illustrates a very rare chronic granulomatous disease called the Madura foot or also called mycetoma. It is a chronic granulomatous disease, caused by a contained infection that penetrates the subcutaneous tissues and spreads to the nearby bone by damaging the affected area's vascularization. Early diagnosis is greatly aided by clinical history and imaging, especially if the "dot-in-circle" sign-a pathognomonic marker of mycetoma-is seen on the MRI. Compared to ordinary radiographs, computed tomography offers a more accurate study of changes in the bone. In order to apply the appropriate course of treatment, it is critical to identify the causal species, which can be caused by either a true fungus (eumycetoma) or a bacterium Actinomyces (Actinomycetoma). Treatment can be extremely challenging and can even result in amputation, particularly if the diagnosis is delayed., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Abstract Mycetoma is a localized chronic subcutaneous infection caused by fungi. It is clinically characterized by a triad of tumefaction, sinuses, and discharge containing typical grains. Eumycetoma, a subtype, is characterized by a low cure rate. Long‐term medication and surgical excision are required to treat the infection. Radiotherapy, a less used modality of treatment, may provide a good salvage option for refractory eumycetoma. Herein, we present a case and a review of the literature of refractory eumycetoma of the foot where radiotherapy was used as a salvage treatment. In the present case, a dose of 17.5 Gy in five fractions was delivered, and the response was assessed as per the Response Evaluation Criteria in Solid Tumors 1.1, discharging grains status, and Dermatology Life Quality Index. The literature on the use of radiotherapy for mycetoma was found to be scanty. In the present case with radiotherapy, there was a partial radiological response, resolution of discharging grains, and improvement in the Dermatology Life Quality Index score. However, the benefit was short‐lived, but re‐irradiation and low‐dose radiotherapy resulted in sustained benefits until 15 months of follow up. The antiproliferative and anti‐inflammatory actions of radiotherapy can be exploited in the treatment of rare, medically difficult to treat mycetoma. This case report may serve as a basis for further evaluation.

Pooja Agarwal, Ashish Jagati, Santoshdev P Rathod, Kirti Kalra, Shefali Patel, Malay Chaudhari Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, IndiaCorrespondence: Kirti KalraDepartment of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, OPD Room No. 16, Ahmedabad, Gujarat, IndiaTel +91 9416917766Email kirtidudeja69@gmail.comAbstract: Mycetoma is a chronic, suppurative and debilitating granulomatous infection seen mainly in tropical and subtropical areas and is now declared as a neglected tropical disease by the World Health Organization. The clinical diagnosis is usually characterized by a classical triad of localized swelling, underlying sinus tracts, and production of grains or granules, but unusual presentations are also seen. It is classified into eumycetoma caused by the fungus, and actinomycetoma caused by the bacteria. The clinical presentation of both is almost similar and a definite diagnosis is essential before starting the treatment as it differs for both. Surgical debulking followed by a prolonged course of medical therapy now forms the mainstay of treatment due to the long course of the disease and suboptimal response. This review focuses on the various usual as well as unusual clinical presentations of mycetoma, established treatment regimens as well as recent changes in the mode of administration of drugs and newer drugs for mycetoma.Keywords: actinomycetoma, eumycetoma, Madura foot, treatment

Madura foot or mycetoma pedis is a chronic granulomatous disease of the foot caused by fungus or gram-positive aerobic bacteria. It is commonly encountered in tropical and subtropical countries but is rare in Malaysia. We report a 40-yearold Rohingya refugee, a resident in Malaysia for the past 11 years, who presented with a long-standing left foot mass that was proven to be a eumycetoma. Wide local excision of the mass and full-thickness skin graft were done, followed by a 6 -month course of postoperative itraconazole. He subsequently recovered well without any sequela. A high index of suspicion should be raised in a patient presenting with a chronic mass and discharging sinus in order to diagnose and treat mycetoma as early initiation of therapy leads to better outcomes. Based on literature review, we propose a new classification of eumycetoma and its treatment guidelines. [ABSTRACT FROM AUTHOR]

Abstract Background Mycetoma is a chronic granulomatous subcutaneous infection caused by anaerobic pseudofilamentous bacteria or fungi. It is commonly prevalent in tropical and subtropical countries. Men are more susceptible to the disease due to greater participation in agricultural works. Mycetoma commonly involves lower extremities, wherein untreated cases lead to aggressive therapeutic choices, such as amputation of the affected body organs and consequently lifelong disability. Case presentation In this report, we present the rare case of a 58-year-old man, originally from Algeria with a left foot chronic tumefaction of 5 years. In the initial clinical examination, mycetoma was diagnosed based on tumefaction and the presence of multiple sinuses with the emission of white grains. The latter was observed via direct examination. The histopathological analysis demonstrated an actinomycetoma caused by bacteria, as the etiological agent. Imaging showed a bone involvement with osteolysis at the levels of 2nd to 4th metatarsal diaphysis. The mycological and bacterial cultures were both negative. For an accurate diagnosis, the obtained grains were subjected to molecular analysis, targeting the 16S-rDNA gene. Molecular identification yielded Actinomadura madurae as the causal agent, and 800/160 mg of trimethoprim/sulfamethoxazole was prescribed twice a day for 1 year, as a treatment. Conclusion Considering low information about this disease, especially in non-endemic areas, it is of high importance to enhance the knowledge and awareness of clinicians and healthcare providers, in particular in the countries with immigration issues.

• Infection with Pseudallescheria boydii has increased among immunocompromised patients • P. boydii has been shown to be pathogenic in immunocompetent patients • It mimics histological features of aspergillosis • Early detection reduces the risk of mortality • Surgical resection along with appropriate antifungal therapy is advocated [ABSTRACT FROM AUTHOR]

Mycetoma is a localized chronic subcutaneous infection caused by fungi. It is clinically characterized by a triad of tumefaction, sinuses, and discharge containing typical grains. Eumycetoma, a subtype, is characterized by a low cure rate. Long‐term medication and surgical excision are required to treat the infection. Radiotherapy, a less used modality of treatment, may provide a good salvage option for refractory eumycetoma. Herein, we present a case and a review of the literature of refractory eumycetoma of the foot where radiotherapy was used as a salvage treatment. In the present case, a dose of 17.5 Gy in five fractions was delivered, and the response was assessed as per the Response Evaluation Criteria in Solid Tumors 1.1, discharging grains status, and Dermatology Life Quality Index. The literature on the use of radiotherapy for mycetoma was found to be scanty. In the present case with radiotherapy, there was a partial radiological response, resolution of discharging grains, and improvement in the Dermatology Life Quality Index score. However, the benefit was short‐lived, but re‐irradiation and low‐dose radiotherapy resulted in sustained benefits until 15 months of follow up. The antiproliferative and anti‐inflammatory actions of radiotherapy can be exploited in the treatment of rare, medically difficult to treat mycetoma. This case report may serve as a basis for further evaluation. [ABSTRACT FROM AUTHOR]

Mycetoma, a chronic granulomatous disease more common in tropical countries such as India, has been conventionally diagnosed by invasive and time-consuming modalities like biopsy and microbiological culture. This case series aims to stress on the benefits of leveraging magnetic resonance imaging and ultrasonography in the early diagnosis of mycetoma, avoiding the invasive techniques and preventing debilitating complications that may develop from delay in diagnosis.

Eumycetoma caused by Madurella fahalii, a drug-resistant fungus, has never been reported in India. Here, we describe a fatal case of eumycetoma with spinal involvement due to M. fahalii for the first time in India., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Vinaykumar Hallur reports financial support was provided by Indian Council of Medical Research., (Copyright © 2024 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Madura foot, relatively easy to diagnose in tropical countries, is very rare and unrecognized in Morocco, causing diagnostic delays. We present the case of a 54-year-old patient with mycetoma for 3 years who initially consulted two general practitioners, then an endocrinologist and finally a dermatologist in order to be diagnosed correctly. The diagnosis of mycetoma based on biological criteria was established at a late stage of irreversible bone lesions; requiring amputation by the orthopedic team. Mycetomas are fungal or bacterial. Delays in diagnosis and care are frequent in Morocco. The diagnosis is based on biology; however, radiological examinations are necessary to assess the extension. The initial treatment is medicinal. Surgery takes place in late stages.

A60-year-old man came to the orthopedics department with swelling of the entire right foot with multiple painful nodules, which oozed pus and blood intermittently for 25 years [Figure 1]. This caused disability and daily limitations to his lifestyle. He had presented with this complaint several times and was referred to a tertiary care center. Examination of the foot showed a swollen foot and ankle with multiple subcutaneous nodules and draining sinuses.

Mycetoma is a chronic, slowly progressing granulomatous subcutaneous infection caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). The present case report is a rare case of Actinomycotic Mycetoma involving wrist due to Streptomyces species. A 53-year-old male presented with multiple swellings over the right wrist and forearm with sinuses discharging seropurulent pus since 3 years. Patient underwent incision and drainage and appropriate antibiotic course after the complete diagnosis. This case report emphasises the role of meticulous clinical examination assisted by microbiological cultures and histopathological studies which are mandatory in the diagnosis, management and assessment of the prognosis of such unusual cases.

Mycetoma is a chronic subcutaneous granulomatous inflammation due to infection by fungus (Eumycetes) and bacteria (Actinomycetes) by penetrating inoculation of the microorganism into an injured skin. Late presentation is common, which leads to various deformities. In a standard setting, mycetoma diagnosis requires a combination of clinical assessment, histopathological features, and culture. However, microbiological culture takes time to be ready. Therefore, the classical histomorphological features supported by histochemical stains are the options to provide a fast diagnosis for the commencement of appropriate treatment. We described two cases of eumycetoma and actinomycetoma, emphasising the differences in their histomorphological features and histochemical stains that may facilitate the diagnosis. [ABSTRACT FROM AUTHOR]

Madura foot, relatively easy to diagnose in tropical countries, is very rare and unrecognized in Morocco, causing diagnostic delays. We present the case of a 54-year-old patient with mycetoma for 3 years who initially consulted two general practitioners, then an endocrinologist and finally a dermatologist in order to be diagnosed correctly. The diagnosis of mycetoma based on biological criteria was established at a late stage of irreversible bone lesions; requiring amputation by the orthopedic team. Mycetomas are fungal or bacterial. Delays in diagnosis and care are frequent in Morocco. The diagnosis is based on biology; however, radiological examinations are necessary to assess the extension. The initial treatment is medicinal. Surgery takes place in late stages. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic, granulomatous infection mainly involving the foot and is caused either by bacteria (actinomycetoma) or fungi (eumycetoma). Eumycetoma is notoriously resistant, posing a therapeutic challenge. There are no specific treatment guidelines but generally a combination of systemic antifungals and local surgical treatment is the accepted standard. Advanced unresponsive lesions generally require amputation. We present a case of eumycetoma of 15-year duration with extensive involvement of foot including bones. Patient had been advised amputation from various tertiary care centers but we decided to give a limb salvage trial. The patient underwent soft tissue debridement along with oral antifungal therapy. Additionally, amphotericin B-impregnated bioabsorbable beads were inserted locally into the bony cavities to supplement the treatment. There has been no recurrence till date. This case is reported in view of successful limb salvage in an advanced eumycetoma case with an unprecedented use of adjunctive local antifungal delivery. [ABSTRACT FROM AUTHOR]

Eumycetomas are chronic subcutaneous pseudo-tumoral infections, endemic in arid tropical areas, which are caused by exogenous fungi that produce grains in vivo. The objective of our work is to establish their epidemiological, clinical and mycological profile in our Moroccan context. Therefore, we conducted a retrospective study, extending from 1975 to 2019, compiling all cases of eumycetomas that were diagnosed in the parasitology-mycology laboratory of the Ibn Sina University Hospital of Rabat. The diagnosis, based on the swabbing of exudates and eventual grains or the study of biopsies, included the direct examination of 30% KOH mounts, the realization of appositions colored by May-Grünwald-Giemsa and the incubation on 3 Sabouraud media at 27° and 37 °C. In 44 years, 12 cases of eumycetoma have been diagnosed, with a male to female ratio of 5:1 and a mean age of 44.8 years. The lesions, evolving from 1 to 30 years, were podal in 10 cases, popliteal and gluteal in one case each, with osteolysis in 3 patients. The collected grains were black in 9 cases, white in 2 others. Direct examination was unanimously positive, revealing entangled hyphae, whilst culture isolated Madurella sp. in 9 cases, Trichophyton rubrum , Acremonium sp. in one case each and remained sterile in the last case. The treatment was medical in 8 cases, medico-surgical in 3 others, with loss of sight of most patients. [ABSTRACT FROM AUTHOR]

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary.This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma.

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A 24-year-old girl, without any significant medical history. with seven months' history of a painful tumefaction of his left foot. Physical examination revealed a tumefaction that discharges a purulent exudate containing black granules via skin fistulas. Direct microscopic examination of grains suggests a fungal infection. Standard X-rays of his foot showed no lesion of the bone. So with the combination of the clinical specific lesions and typical grains, a diagnosis of Madura foot was made and the patient treated with surgical debridement, followed by Ketoconazole for 12 months, she is under regular monitoring. Mycetoma is characterized by a clinical triad of chronic induration, draining sinuses and discharge of granules. It is either actinomycotic or eumycotic in etiology. It is endemic in tropical and subtropical countries.

Mycetoma is a chronic, slowly progressing granulomatous subcutaneous infection caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). The present case report is a rare case of Actinomycotic Mycetoma involving wrist due to Streptomyces species. A 53-year-old male presented with multiple swellings over the right wrist and forearm with sinuses discharging sero-purulent pus since 3 years. Patient underwent incision and drainage and appropriate antibiotic course after the complete diagnosis. This case report emphasises the role of meticulous clinical examination assisted by microbiological cultures and histopathological studies which are mandatory in the diagnosis, management and assessment of the prognosis of such unusual cases. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic-granulomatous disease characterized by the inflammation, swollen organ, draining sinuses containing blood, pus, and grains. We present a case of madura foot with novel etiologic agent Madurella pseudomycetomatis. Diagnosis was based on morphologic, physiologic, histipathologic and molecular methods. In vitro antifungal susceptibility tests revealed that MIC values for itraconazole, amphotericin B, and posaconazole were 0.0313 μg/ml, 0.0313 μg/ml, and 0.004 μg/ml, respectively. The patient was treated and recovered by itraconazole(400 mg/day) after prolonged course. [ABSTRACT FROM AUTHOR]

On 28th May 2016,mycetoma was recognized as a neglected tropical disease by the World Health Organization. This was the result of a 4-year journey starting in February 2013 with a meeting of global mycetoma experts. Knowledge gaps were identified and included the incidence, prevalence, and mapping of mycetoma; the mode of transmission; the development of methods for early diagnosis; and better treatment. In this review, we review the road to recognition, the ISHAM working group meeting in Argentina, and we address the progress made in closing the knowledge gaps since 2013. Progress included adding another 9000 patients to the literature, which allowed us to update the prevalence map on mycetoma. Furthermore, based on molecular phylogeny, species names were corrected and four novel mycetoma causative agents were identified. By mapping mycetoma causative agents an association with Acacia trees was found. For early diagnosis, three different isothermal amplification techniques were developed, and novel antigens were discovered. To develop better treatment strategies for mycetoma patients, in vitro susceptibility tests for the coelomycete agents of black grain mycetoma were developed, and the first randomized clinical trial for eumycetoma started early 2017. [ABSTRACT FROM AUTHOR]

Madura foot is a chronic infectious disease, caused by bacterial actinomycetes or by fungi. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. The diagnosis is made by clinical picture, direct microscopic examination and histological study. The best therapeutic choice is surgical removal of the lesion, followed by medical treatment. An earlier diagnosis and treatment can elicit good results. We report a case of eumycetoma in a 33 year-old Moroccan man, rural worker, treated by Ketoconazole in 12 months, associated with surgical debridement. The evolution was marked by the complete remission of the infection.

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary.This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma. [ABSTRACT FROM AUTHOR]

Madura foot is a rare, loca, chronic granulomatous skin infection which commonly affects the adult male foot. Medical treatment reduces the size of the lesion but surgical excision is necessary for radical treatment. We present a case of a 59 year old male farmer diagnosed as actinomadura of the right foot treated with medical treatment, total excision, negative pressure wound therapy and split thickness skin graft.

Mycetoma or ‘Madura foot’ is a chronic infection of skin and subcutaneous tissues, fascia and bone. It may be caused by true fungi (eumycetoma) or by filamentous bacteria (actinomycetoma). The lesions are composed of suppurating abscesses and draining sinuses with the presence of grains which are characteristic of the etiologic agents. The introduction of new broad spectrum antimicrobials and antifungals offers the hope of improved drug efficacy. This article discusses the historical aspects, epidemiology, clinical findings, laboratory diagnosis and treatment of mycetoma.

Madura foot or mycetoma is a chronic granulomatous disease characterized by localized infection of subcutaneous tissues by actinomycetes or fungi. The inflammatory response can extend to the underlying bone. Mycetoma was described first in the mid 1800s and was initially called Madura foot. The infection can be caused by true fungi (eumycetoma) in 40%, or filamentous bacteria (actinomycetoma) in 60%.Actinomycetoma may be due to Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis, Nocardia species. The infection, which may remain latent for a time, forms small, subcutaneous swellings that enlarge, soften with pus, and break through the skin surface, with concurrent invasion of deeper tissues. Sulfonamide, iodide, and antibiotic therapy have been used against actinomycotic infections, but the fungi are more resistant to treatment. We reported a patient of madura foot from International Medical College Hospital, Tongi, Gazipur. A 82-years old male was admitted to the International medical college hospital with a 16 months history of swelling with multiple discharging sinuses filled with granules localized in his right foot. Pus was examined by gram staining and periodic acid Schiff (PAS) staining. Moderate number of filamentous branching gram positive bacilli were found . The organism was recognized as a member of the actinomyces genus. PAS staining did not reveal any other organism. The aggressive course and progression of the disease affected the short bones of the involved foot. The patient was diagnosed as a case of Madura foot and was treated in the same hospital.