Mycetoma of the upper back: an unusual presentation of a neglected tropical disease

Mycetoma is a chronic, granulomatous infection typically affecting the lower limbs. We report a rare case of eumycetoma involving the upper back in a young man with a 10-year history of painless swelling that became symptomatic only recently. After initially diagnosed as an abscess, intraoperative discovery of black granules prompted further investigation. Histopathology confirmed <i>Madurella mycetomatis</i> infection. Imaging revealed a large heterogeneous mass without bone involvement. The patient underwent complete surgical excision followed by oral itraconazole therapy. At 1 month follow-up, postoperative recovery was uneventful, without recurrence. This case highlights the importance of involving mycetoma in the differential diagnosis of chronic soft tissue swellings, even in rare anatomical sites. Early suspicion, tissue biopsy and MRI are the determinants of accurate diagnosis. Public and clinician awareness is vital, particularly in endemic areas, to prevent misdiagnosis and reduce morbidity. To our knowledge, this is among the few documented cases of extrapedal eumycetoma.