A 57-year-old man with no history of human immunodeficiency virus (HIV) infection, immunodeficiency or consumption of immunosuppressive drugs was admitted to hospital in Isfahan, with symptoms including a 4-month history of a cutaneous wound on his left foot acquired during agriculture, persistent fever (39  C), weakness, persistent non-productive cough and chest pain; a chest x-ray was taken and evaluation of radiological pictures showed nodular lesions across both lungs (Fig. 1); Purified protein derivative (PPD) test was negative and a erythrocyte sedimentation rate (ESR) of 57 mm h-1 was present. The patient was suspected of having tuberculosis,  Staphylococcus aureus  was isolated from his foot wound and anti-tuberculosis drugs were initiated. However, the patient was not treated after 2 weeks and his cutaneous wound had not improved and developed into a productive large lesion, expelling yellow-wan pus similar to mycetoma (Fig. 2).