Extensive Streptomyces somaliensis actinomycetoma lesion; a case report

Alaa Tajeldeen Habeeb, Asma Adam Osman, Ahmed Hassan Fahal

A  58-year-old male farmer from Jabal Marrah, Central Darfur State, Sudan, presented on march 2022 to the Mycetoma Research Center, University of Khartoum, Khartoum, Sudan, with a massive painless right thigh swelling with multiple sinuses for 12 years. The swelling progressed gradually in size to involve the whole thigh. He has no previous treatment for that, no family of similar condition or local trauma. He has no other medical condition and was not on long-term medication.

Fig 1: The thigh lesion at the presentation


On general systemic examinations, no abnormality was detected. Local examination revealed a massive right thigh mass around 40 by 30 cm,  extending from the right knee to the groin area. The right limb was externally rotated, with obvious asymmetry between the two lower limbs. There were multiple active sinuses discharging sero-bloody fluid. The mass was non-tender, of normal temperature, firm in consistency with no local hyperhidrosis

Fig 2: The lesion after six-week treatment


Laboratory and imaging investigations confirmed the diagnosis of Streptomyces somaliensis caused actinomycetoma. He was started on  Amoxicillin/clavulanic acid one gram twice a day, Co-trimoxazole 960mg twice daily, and folic acid 0.5mg once daily. He showed reasonable improvement after a six-week treatment.