Cerebral mycetoma with cranial osteomyelitis

Craniocerebral maduromycetoma is extremely rare. The authors describe a case of maduromycetoma involving the left parietal cortex, bone, and subcutaneous tissue in a young male farm laborer who presented with left parietal scalp swelling that had progressed into a relentlessly discharging sinus. Computed tomography (CT) scanning of his brain revealed osteomyelitis of the parietal bone with an underlying homogeneously enhancing tumor. Intraoperatively, the mass was revealed to be a black lesion involving the bone, dura mater, and underlying cerebral cortex. It was friable and separated from the surrounding brain by a thick gliotic scar. Gross-total excision was performed, and the patient was placed on a 6-week regimen of itraconazole. To the authors' knowledge, this is the first instance of cerebral mycetoma with CT findings reported in the literature.