Clinical Images Aggressive actinomycetoma

Abstract

A 29-year-old woman from Western Sudan presented to the Mycetoma Research Centre, Khartoum, Sudan
with massive anterior abdominal wall, upper right thigh and perineal swelling (Panel A). The lesion started
with a small painless right foot swelling seven years prior to presentation and gradually increased in size.
Eventually it was necessary to perform below knee amputation at a district hospital.
Five years prior to presentation, a painless right inguinal swelling appeared followed by multiple sinuses
producing sero-purulent discharges containing small tiny whitish grains. The swelling gradually spread to
involve the lower abdominal wall, right upper thigh, groin, vulva and perineum.
Surgical biopsy from the lesion and grains culture confirmed the diagnosis of actinomycetoma due to
Streptomyces somalensis. Abdominal magnetic resonance imaging revealed massive intra-abdominal
disease spread (Panel B).
Eight cycles of combination of Amikacin sulphate 15 mg/kg a day for three weeks and 840 mg of Cotrimoxazole bd for five weeks was administered. She had a dramatic improvement (Panel C). She had two
successful pregnancies and gave birth to two healthy children by Caesarian section.
This is a case of a right foot actinomycetoma, which spread to the inguinal lymph nodes and formed
secondary satellite leading to an aggressive local and intra-abdominal involvement. She fortunately
responded well to treatment