Weeping Leg'

Description 

A 37-year-old daily wager from Uttar Pradesh in Northern India presented with multiple painless small nodules and granules discharging sinuses over the left leg. The lesions were uniformly distributed below the knee up to the ankle crease (figure 1). The skin was puckered and tethered to the underlying tissues. However, the foot and thigh of the involved limb and rest of the other limbs were absolutely symptom free. Radiographs showed erosion of the entire tibia and fibula with mixed sclerotic and osteolytic areas (figure 2, black arrows) along with sub tissue swelling and periosteal reactions (figure 2, white arrows). The culture of the grains  in Modified Sabouraud Agar media supplemented with 0.5% yeast extract revealed Madurella mycetomatis from its characteristic colony of fruiting bodies.

Figure 1

Clinical photograph of the left leg of the patient showing multiple discharging sinuses with...

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