Subekcha Karki1* and Ma Luisa Abad-Venida2
1Resident, Department of Dermatology, Jose R Reyes Memorial medical Centre, Manila, Philippines
2Consultant, Research and Training Officer, Jose R Reyes Memorial medical Centre, Manila, Philippines
Received: 10 August, 2015; Accepted: 22 September, 2015; Published: 25 September, 2015
Subekcha Karki, MD, Assistant Dermatologist to the Chair, Di Skin Hospital, Maharajgunj, Kathmandu, Nepal, E-mail:
Karki S, Abad-Venida ML (2015) A Case of Actinomycetoma Treated with Trimethoprim + Sulfamethoxazole. Int J Dermatol Clin Res 1(2): 020-023. DOI: 10.17352/2455-8605.000009
© 2015 Karki S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Actinomycetoma; Trimethoprim-sulfamethoxazole (SMX+TMP)
A 32-year-old man presented with a history of progressive, painful nodular growths with discharge consisting granules over the right thigh, inguinal area and right foot. Histopathological examination of the tissue biopsy was actinomycotic mycetoma. The patient showed improvement with trimethoprim-sulfamethoxazole. The novelty of our case is to use Co-trimoxazole as a first line treatment modality for cases diagnosed or suspected as actinomycetoma.
Actinomycetoma is a chronic suppurative and or granulomatous infectious process caused by aerobic filamentous bacteria. Actinomycetomas are caused by members of genus Nocardia, Streptomyces, Nocardiopsis, and Actinomadura.
The term mycetoma, coined by Vandyke Carter in 1860, suggests a fungal growth; however, aerobic filamentous bacteria cause most cases worldwide . We report an advanced stage of actinomycetoma. To the best of our knowledge cure is possible, although a prolonged period is needed. Recurrence is common after an incomplete or irregular course of medical treatment.
There are no existing acceptable treatment protocols or guidelines for mycetoma. The available treatment options are based on personal experience, preference and drug availability.
A 32-year-old Filipino male who worked as a farmer and a food-vendor, from Tondo, Manila presented with a history of progressive multiple nodules over the right lower limb associated with seropurulent discharge.
Eight years prior to consultation, patient had penetrating injury by a bamboo stick over the right foot, after which he developed a solitary mass measuring approximately 1x1cm gradually increasing in number and size. Surgical consultation was done and underwent tumor excision and split thickness skin graft from the right thigh. I.V. antibiotics were given post-surgically for a week and oral-antibiotics continued for a week more. He was asymptomatic for 8 years after which he sought medical consult, when there was difficulty in breathing, progressive multiple nodules over the right-foot, right-thigh and right-inguinal area associated with seropurulent discharge. He was confined in Internal Medicine and co-managed with Orthopedics with assessment to consider Osteosarcoma right leg.
Laboratory investigations revealed a decrease in hemoglobin 104g/dL (n.v 135-180g/dL) and hematocrit 0.40-0.54% (n.v 0.25%), leucopenia 21.05 (n.v 5-10 X 109). Urinalysis revealed normal results.
It was essential to carry out HIV serology in our patients, according to the patient his HIV serology was done few months prior and was negative but the results were not available, hence not repeated.
His Chest X-ray PA and Lateral view revealed pleural effusion vs. pleural thickening right, PTB R. upper lobe, pleurodiaphragmatic adhesion bilateral. X-ray of the pelvis suggested arthritic hip, probably infectious in origin and R. foot revealed soft tissue masses in the 1st & 2nd intradigital space, beginning osteomyelitis 2nd metatarsal right (Figures 1-4).