What Can Imaging Do for Mycetoma in an Immunocompetent Patient in Temperate Region

Abstract

Mycetoma is a slowly persistent granulomatous infection of the cutaneous and deep subcutaneous tissue structures. It is caused by true fungi (eumycetoma) or bacteria (actinomycetoma), which is usually endemic in tropical countries. It may be misdiagnosed and delayed by low clinical suspicion, limited availability of diagnostic techniques, lack of biopsy and microbiological culture, potentially leading to disastrous consequences. Therefore, imaging plays a vital role in early recognition as a non-invasive technique, especially Magnetic resonance imaging, which demonstrates a hallmarked “dot-in-circle” sign of mycetoma. In this paper, we will present an immunocompetent patient with nearly two decades of history and review literature to highlight the importance of increasing awareness of mycetoma, particularly in non-endemic regions. The final diagnosis was made based on the characteristic “dot-in-circle” findings on Magnetic resonance images and pathologically confirmed.