Left Gluteal and Perianal Eumycetoma Lesion Extending Into the Left Greater Sciatic Foramen, Pelvic Cavity to the External Anal Sphincter.

Mycetoma is a chronic subcutaneous infection that primarily affects the lower extremities, although atypical anatomical presentations are possible. We describe a Sudanese farmer, age 31, who developed a left gluteal eumycetoma due to Madurella mycetomatis. Magnetic resonance imaging (MRI) showed widespread deep tissue involvement that extended into the pelvic cavity, sciatic foramen, and external anal sphincter despite a minor external lesion. Over the course of a year, the patient showed clinical improvement with lesion encapsulation while receiving oral itraconazole. In order to prevent advanced, debilitating complications, this case emphasizes the deceptive nature of mycetoma's superficial appearance, the vital role of MRI in disease assessment, and the significance of early detection through public health education in endemic regions.