We describe a case of mycetoma caused by Actinomadura pelletieri with simultaneous involvement of thè spine, abdominal wall and retroperitoneal space in a man who had suffered from 'Madura foot' 10 years earlier. The characteristics of this case were analysed and contextualized among those of other cases of mycetoma caused by other micro-organisms found through a review of thè international literature. The rarity of thè disease in industrialized countries and its possible atypical presentations may hinder a prompt diagnosis. Culture techniques that allow detection of slow-growing fungi and actinomycetes should be routinely used when dealing with tissue samples from patients from tropical and subtropical regions with chronic granulomatous infections.