Subcutaneous nodules, some 20 years after a fall in Namibia, diagnosed in Belgium: imported pathology may take a long time before diagnosis

A 30-year-old black Namibian man was admitted to our hospital suffering from painless subcutaneous nodules on the right side of his trunk after a fall into an acacia tree as a teenager. As a child he had worked in the fields in northern Namibia. All nodules were removed by surgical excision and were described by the surgeon as black lead-shot-like particles sized 1–2 mm. Fascia was left intact. Conventional x rays showed no invasion of the deeper layers. Stained sections (H&E) revealed the typical rust-brown cement-like elements as seen in Madurella mycetomatis grains.1–3 The typical diffusion of the extracellular pigmented …