Mycetoma is a slowly progressive, chronic granulomatous infection that primarily affects the skin, subcutaneous tissue, and deeper structures, with a predilection for the lower limbs. In this report, we describe a case of a 26-year-old male construction worker who presented with complaints of painful, elevated lesions on his left foot. On examination, there were multiple, well-defined, erythematous to skin-colored plaques with erosions and crust formation, predominantly over the left foot and extending to the left thigh region. The patient had a history of repeated hospital admissions due to exacerbation of symptoms, largely attributed to his poor compliance with prescribed medications and disregard for medical advice regarding inpatient care. Microbiological examination confirmed the presence of Actinomadurae species. Consequently, the patient was managed with a modified two-step Ramam therapeutic protocol. This case highlights the critical impact of medication non-adherence and limited healthcare access, both of which can prolong the duration of treatment and complicate disease management. Prompt diagnosis, accurate identification of the causative pathogen, and a patient-centered therapeutic approach are essential to achieve favorable clinical outcomes.
