Work

A rare presentation of actinomycotic mycetoma of the hand: a case report

Year: 2026

Type: article

Abstract: BACKGROUND: Mycetoma is a chronic granulomatous subcutaneous infection caused by fungi (eumycetoma) or bacteria (actinomycetoma). The classic triad includes a mass, sinus tracts, and discharge containing granules. We present an atypical case of actinomycotic mycetoma of the hand without sinus formation. CASE PRESENTATION: An 85-year-old male farmer presented with an 8-year history of a progressively enlarging, painful mass on his left hand; he recalled that the initial lesion began as a painless pustule on the palm approximately 9 years earlier. Prior surgeries and short-course antibiotics failed. Examination revealed an indurated, erythematous mass with restricted motion but no draining sinuses. Computed tomography showed soft tissue swelling and bone erosion. Histopathology revealed yellow granules with filamentous bacteria, and the diagnosis was confirmed by RT-PCR using pan-actinomycetes primers. The patient was started on combination therapy with penicillin V and trimethoprim-sulfamethoxazole. CONCLUSIONS: This case underscores that mycetoma can present without classic sinus tracts, leading to diagnostic delay. A high index of suspicion and the use of histopathological and molecular methods are essential for diagnosis. Prolonged, targeted antibiotic therapy is the cornerstone of management, though advanced disease may result in a slower response.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-026-12825-6

Authors: Shahrzad Layegh Mirhosseyni, Armin Abdi, Mohammad Kord, Kazem Ahmadikia, Ilad Alavi Darazam

Institutions: Shahid Beheshti University, Shahid Beheshti University of Medical Sciences, Tehran University of Medical Sciences

Language: English

Topic: Actinomycetales infections and treatment

Subfield: Microbiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090