Eumycetoma with Exophiala jeanselmei 27 years after a splinter

Mycetoma is a chronic infectious disease of either bacterial (actinomycetoma) or fungal (eumycetoma) origin and is rarely encountered in the United States. Infections are usually associated with trauma and implantation of the organism into the skin/soft tissue, but symptoms may not occur for some time after the infecting event. Classically, findings include a subcutaneous infection at the site of previous trauma with the development of draining sinuses extruding grains of the causative microorganism. A variety of organisms can be associated with the disease, and diagnosis and treatment can be difficult. We report a case of eumycetoma with Exophiala jeanselmei that presented 27 years after presumed inoculation and review the literature on presentation, diagnosis, and treatment.