Mycetoma is a chronic localized progressive granulomatous infection of the skin involving subcutaneous and deeper tissues, commonly affecting the lower extremities. We report a case of a 26-year-old male construction worker presented with chief complaints of painful red to skin-colored raised lesions present over his left foot, lesions were multiple discrete erythematous to skin-colored plaques with well-demarcated erythematous erosions and crusting present over the left foot and left thigh region. The patient had been hospitalized several times due to worsening symptoms because of his nonadherence to medications and negligence toward health and medical advice of hospital inpatient admissions. Actinomadurae was isolated and a modified 2-step Ramam treatment regimen was initiated. This case is presented to signify how medication non-adherence and poor health facilities can lead to an increase in treatment course and duration. Early detection and identification of the causative organism and individualized treatment plans are necessary for a better clinical outcome.
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