771 Case Report A 47-year old male farmer from Gezira State, Central Sudan, was referred to the Mycetoma Research Centre, Khartoum, Sudan with one month history of left hip joint pain and stiffness. The pain was continuous, severe and aggravated by the hip joint movements. It was radiating to the left knee joint and left leg and retention associated with constant severe suprapubic pain. His urine retention was relieved by urinary catheterization and the drained urine was founded to be infected and bloody. He had no pyrexia or sweats but had mild weight loss. Three years prior to presentation he had painless perineal swellings with multiple discharging sinuses. The discharge was purulent and contained black grains. The diagnosis of eumycetoma was established. His condition progressed and he underwent wide local excision, followed by anterior rectal resection and a permanent colostomy elsewhere. The indication for the rectal resection was unclear. He was known to have end stage renal failure secondary to essential hypertension and had a renal transplantation in 2005 and was on immuno- suppression treatment in the form of prednisolone and mycophenolate mofetile. He was a farmer of low socio-economic status and had a history of local trauma at the mycetoma site but there was no family history of mycetoma. Clinical examination revealed an unwell pale, irritable and confused man in severe pain. His pulse rate was 90/min, respiratory rate was 19/min, temperature was 37.5 0 C and his blood pressure was 130/70. The examination of his cardiovascular, respiratory, central nervous systems and back were within normal. Abdomen was soft non tender with a permanent colostomy in the left iliac fossa. On local examination, there were multiple discharging sinuses in the inguinal, pubic, supra-pubic regions and left upper thigh. The discharge was purulent containing black grains. There were multiple non and deep structures. There was no regional lymph nodes enlargement. Perineal and gluteal regions examination revealed the absence of the anus and there were multiple discharging sinuses that contained black grains (Figure. 1). The left hip joint was stiff and tender on movement. Case Reports Aggressive perineal and pelvic eumycetoma: An unusual and challenging problem to treat El Semani Widaa Mohamed, Suliman Hussein, Adil Ibrahim Fadella, Ahmed Hassan Fahl* Mycetoma Research Centre, University of Khartoum, Department of Surgery, Faculty of Medicine, University of Khartoum Abstract In this short communication, we report the case of a 47-year old male farmer with a renal transplant from Central Sudan. He was seen at the Mycetoma Research Centre, Khartoum, Sudan with one month history of acute urine retention and severe left hip joint pain and stiffness. The clinical examinations and investigations revealed massive perineal and intra-pelvic eumycetoma. This is a rare and unusual presentation of eumycetoma. Regrettably the treatment offered to him was unsuccessful and he died from uncontrolled disease and sepsis. He was on immune-suppression treatment for a renal transplantation and that may partially explain the aggressive * Corresponding author: Mycetoma Research Centre, University of Khartoum. PO Box 102 - Khartoum- Sudan. E-mail: ahfahal@hotmail.com, ahfahal@uofk.edu Khartoum Medical Juornal (2012) Vol. 05, No. 2, pp. 771 - 774