Images in Clinical Medicine
Madura Foot
N Engl J Med 2012; 366:e2January 5, 2012
- Article
A 40-year-old woman was referred to the dermatology department for evaluation of the right foot, in which swelling and nodules had been present for 11 years. The nodules were painful, drained material periodically, and made weight-bearing difficult. Previous treatment took place in Mexico and included a short course of an unknown antibiotic, which resulted in minimal improvement. Examination of the plantar, dorsal, and medial surfaces of the foot (Panels A, B, and C, respectively) showed soft-tissue swelling, multiple red, boggy, subcutaneous nodules, and draining sinus tracts. Culture of a specimen from a punch biopsy failed to grow any organisms. However, histologic analysis revealed whitish-yellow granules and the presence of non–acid-fast filamentous bacteria consistent with Madura foot. This condition can be caused by either filamentous actinobacteria (actinomycotic mycetoma) or true fungi (eumycotic mycetoma). The pale color of the granules combined with the fact that the patient was from Mexico, where most mycetomas are caused by actinomadura species, made actinomycotic mycetoma the more likely diagnosis. Magnetic resonance imaging of the foot was performed, and the scan obtained indicated possible osteomyelitis. The patient is being treated with doxycycline, and after 8 months of therapy the foot has regained much of its normal appearance.
Amanda Jane Pickert, M.D.
Mayo Clinic Arizona, Scottsdale, AZXuan Nguyen, M.D.
Maricopa Integrated Health System, Phoenix, AZ
