Primary mycetoma infection of the distal tibia secondary to an occult foreign body.

Mycetoma infections of the extremities usually present with characteristic cutaneous manifestations of a locally invasive chronic infection. Primary mycetoma infection of bone can occur by direct inoculation of the fungus to a bony prominence from a penetrating injury. The clinical presentation, the surgical management, and the use of oral antifungal agents differentiate primary mycetoma of bone from chronic mycetoma infections.