Uncommon Lumbar Presentation of White Mycetoma Successfully Managed with Wide Excision and Skin Grafting: A Case Report from Sudan

White mycetoma is a chronic, granulomatous infection caused by fungal organisms, typically affecting the lower limbs of individuals in tropical and subtropical regions. Atypical anatomical presentations, such as lumbar involvement, are rare and pose diagnostic and therapeutic challenges. This case report describes a 53-year-old male farm worker from Gezira State, Sudan, who presented with a 10-month history of painless swellings and multiple sinuses in the right lumbar region. The patient had prior exposure to stagnant farm water and a previous episode of discharging sinuses diagnosed as white mycetoma. Clinical examination revealed a mixture of healed and active sinuses with underlying fibrosis. Laboratory investigations were unremarkable, and initial antibiotic therapy led to cessation of discharge. Due to the extent of tissue involvement, wide local excision was performed under general anesthesia, followed by split-thickness skin grafting. Histopathological analysis confirmed the diagnosis of white mycetoma, showing fungal granules surrounded by dense inflammatory infiltrate and fibrotic tissue. The patient recovered uneventfully, with satisfactory graft uptake and no immediate postoperative complications. This case highlights the importance of considering mycetoma in differential diagnoses of chronic soft tissue infections in endemic areas, especially when presentation is atypical. It also underscores the role of surgical intervention in advanced cases and the challenges posed by limited diagnostic infrastructure in conflict-affected regions. Early recognition, multidisciplinary management, and resilient laboratory systems are essential for improving outcomes in mycetoma-endemic settings.