Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report

Actinomycetoma is a chronic, localised, progressive granulomatous infection of the skin and subcutaneous tissues, typically affecting the lower extremities. It is caused by Actinomycetes bacteria, which are commonly found in soil and water. The infection usually results from minor trauma, such as wa...

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Main Authors: Sandra Arora, Jahanvi Goyal, Sanjeev B Gupta, Aayush Gupta
Format: Article
Language:English
Published: JCDR Research and Publications Private Limited 2025-05-01
Series:Journal of Clinical and Diagnostic Research
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Online Access:https://jcdr.net/articles/PDF/20959/78910_CE[Ra1]_F(IS)_QC(PS_OM)_PF1(AG_SL)_PFA(IS)_PB(AG_IS)_PN(IS).pdf
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author Sandra Arora
Jahanvi Goyal
Sanjeev B Gupta
Aayush Gupta
author_facet Sandra Arora
Jahanvi Goyal
Sanjeev B Gupta
Aayush Gupta
author_sort Sandra Arora
collection DOAJ
description Actinomycetoma is a chronic, localised, progressive granulomatous infection of the skin and subcutaneous tissues, typically affecting the lower extremities. It is caused by Actinomycetes bacteria, which are commonly found in soil and water. The infection usually results from minor trauma, such as walking barefoot or exposure to thorny vegetation. Upon inoculation, the bacteria form grains that help evade the host immune response, facilitating the establishment of infection. It is characterised by discharging sinuses and the presence of granules. This condition predominantly affects individuals in rural, resource-limited areas with limited access to healthcare. Although it affects both men and women, men are more commonly affected due to occupational exposure. The disease progresses slowly, often leading to severe complications, including tissue destruction and sinus tract formation, with amputation being the only option in advanced cases. Authors hereby report a case of Actinomycetoma in an 86-year-old male farmer who presented with painful erythematous nodules and purulent discharge from lesions on his left leg for the past four years. The diagnosis was established through clinical, histopathological and microbiological investigations, including Gram stain, Gomori Methenamine Silver (GMS), and Periodic Acid-Schiff (PAS) stain. Treatment with a combination of amoxicillin-clavulanic acid and trimethoprim/sulphamethoxazole was initiated. This led to a complete resolution of the condition within three weeks, demonstrating the efficacy of this treatment as a safe and cost-effective option. This case highlights the importance of early diagnosis and appropriate treatment for Actinomycetoma, emphasising the value of affordable therapeutic interventions.
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institution Kabale University
issn 2249-782X
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spelling doaj-art-5b0a9d6ddce140ccbdf7a90d1635a0932025-08-20T03:47:32ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-05-01195WD01WD0310.7860/JCDR/2025/78910.20959Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case ReportSandra Arora0Jahanvi Goyal1Sanjeev B Gupta2Aayush Gupta3Junior Resident, Department of Dermatology, Venereology, Leprosy, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.Junior Resident, Department of Dermatology, Venereology, Leprosy, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.Professor, Department of Dermatology, Venereology, Leprosy, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.Professor and Head, Department of Dermatology, Venereology, Leprosy, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.Actinomycetoma is a chronic, localised, progressive granulomatous infection of the skin and subcutaneous tissues, typically affecting the lower extremities. It is caused by Actinomycetes bacteria, which are commonly found in soil and water. The infection usually results from minor trauma, such as walking barefoot or exposure to thorny vegetation. Upon inoculation, the bacteria form grains that help evade the host immune response, facilitating the establishment of infection. It is characterised by discharging sinuses and the presence of granules. This condition predominantly affects individuals in rural, resource-limited areas with limited access to healthcare. Although it affects both men and women, men are more commonly affected due to occupational exposure. The disease progresses slowly, often leading to severe complications, including tissue destruction and sinus tract formation, with amputation being the only option in advanced cases. Authors hereby report a case of Actinomycetoma in an 86-year-old male farmer who presented with painful erythematous nodules and purulent discharge from lesions on his left leg for the past four years. The diagnosis was established through clinical, histopathological and microbiological investigations, including Gram stain, Gomori Methenamine Silver (GMS), and Periodic Acid-Schiff (PAS) stain. Treatment with a combination of amoxicillin-clavulanic acid and trimethoprim/sulphamethoxazole was initiated. This led to a complete resolution of the condition within three weeks, demonstrating the efficacy of this treatment as a safe and cost-effective option. This case highlights the importance of early diagnosis and appropriate treatment for Actinomycetoma, emphasising the value of affordable therapeutic interventions.https://jcdr.net/articles/PDF/20959/78910_CE[Ra1]_F(IS)_QC(PS_OM)_PF1(AG_SL)_PFA(IS)_PB(AG_IS)_PN(IS).pdfchronic granulomatous infectionsinus tractssubcutaneous nodules
spellingShingle Sandra Arora
Jahanvi Goyal
Sanjeev B Gupta
Aayush Gupta
Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
Journal of Clinical and Diagnostic Research
chronic granulomatous infection
sinus tracts
subcutaneous nodules
title Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
title_full Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
title_fullStr Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
title_full_unstemmed Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
title_short Amoxicillin-clavulanic Acid and Trimethoprim/Sulphamethoxazole Combination Therapy for Actinomycetoma in an Elderly Farmer: A Case Report
title_sort amoxicillin clavulanic acid and trimethoprim sulphamethoxazole combination therapy for actinomycetoma in an elderly farmer a case report
topic chronic granulomatous infection
sinus tracts
subcutaneous nodules
url https://jcdr.net/articles/PDF/20959/78910_CE[Ra1]_F(IS)_QC(PS_OM)_PF1(AG_SL)_PFA(IS)_PB(AG_IS)_PN(IS).pdf
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