Background: Mycetoma is a rare infective disease caused by fungi or bacteria which leads to chronic, destructive granulomatous inflammation causing tumefaction. Mycetoma predominantly affects the lower limb, with the hand affected in only 4-12% of cases. Prevalence in developed countries is exceptionally low, with mycetoma most commonly reported in Asia, South America and Africa. Aim: This report describes an infective disease of the hand in order to educate Australian surgeons regarding a rare but potentially devastating condition. Case: A 57-year-old male presented with a 2-year history of slow growing lumps of his right hand. He denied trauma, occupational exposure and constitutional symptoms. Examination revealed multiple small, rubbery lumps on the volar surface of the right hand with generalised swelling but intact range of motion and sensation. On CT and MR imaging, erosion of the 3rd metacarpal and collections within the intrinsic hand musculature were found. Intra-op findings during excisional biopsy demonstrated invasive granulomatous inflammation throughout all tissue planes of the hand. Specimens were negative on culture, but histopathology showed filamentous bacteria confirmed to be Actinomadura spp. on 16S rRNA testing. This patient was treated with Trimethoprim/Sulfamethoxazole and Amoxicillin/Clavulanic Acid for 18 months. Conclusion: Current treatment of mycetoma is with antibiotics. However, the hand surgeon must be aware of mycetoma, as patients may be referred for primary surgical review since infection is rarely considered the cause of chronic subcutaneous nodules. Additionally, surgery may be indicated for diagnosis and treatment resistant disease or in conjunction with antibiotics.