Diagnosis and Management of a Long-Standing Eumycetoma of the Wrist in Somalia: A Case Report in a Resource-Limited Setting.

Introduction: Mycetoma is a chronic, progressive, granulomatous inflammatory disease affecting subcutaneous tissues, most commonly caused by traumatic inoculation of certain fungi (eumycetoma) or bacteria (actinomycetoma). Common etiological agents for eumycetoma include Madurella mycetomatis and Trematosphaeria grisea, while actinomycetoma is frequently caused by Nocardia or Streptomyces species. It is endemic in tropical and subtropical regions, including Somalia. The clinical triad of a painless subcutaneous mass, multiple draining sinuses, and the presence of grains in the discharge is characteristic. Case Presentation: We report the case of a 38-year-old female from Baladweyn, Somalia, who presented with a three-year history of a slowly growing, firm, nodular swelling on the ventral aspect of her right wrist. The lesion was accompanied by mild pain and a discharge containing black grains, which are clinically characteristic of dematiaceous fungi such as Madurella species. Her vital signs and preliminary laboratory investigations, including viral screenings, were unremarkable. The patient underwent complete en bloc surgical excision of the 3x2x1 cm mass. Histopathological examination confirmed the diagnosis of eumycetoma, revealing fungal grains surrounded by a dense neutrophilic and granulomatous inflammatory infiltrate. Conclusion: This case illustrates the classic clinical and histopathological presentation of eumycetoma. In a resource-limited setting where species-specific identification via culture or PCR and extensive antifungal therapy may be unavailable, complete surgical excision for localized lesions proved to be a successful and curative management strategy. This report underscores the importance of early diagnosis and surgical intervention in preventing the significant morbidity associated with advanced mycetoma.