Mycetoma is a chronic granulomatous infection that predominantly affects individuals in rural environments and is often associated with delayed diagnosis and progressive tissue destruction. Magnetic resonance imaging (MRI) plays a central role in early recognition, particularly through the identification of the characteristic “dot-in-circle” sign.

We report the case of a 36-year-old male agricultural worker presenting with chronic foot pain and swelling. MRI demonstrated extensive disease with a striking predominance of intraosseous involvement, including multiple tarsal bones, characterized by numerous intraosseous “dot-in-circle” lesions, in addition to soft tissue infiltration and sinus tract formation. Microbiological analysis confirmed mycetoma.

This case highlights an atypical imaging pattern of mycetoma with predominant intraosseous expression, which may mimic multifocal osteomyelitis or neoplastic processes. Recognition of this presentation expands the known imaging spectrum of mycetoma and reinforces the importance of MRI in early diagnosis and disease characterization.