الملخص الإنجليزي
Mycetoma, formerly known as Madura foot, is a chronic, localized, gradually increasing
in size, granulomatous exogenous infection of the skin and subcutaneous tissue with
risks of bone and visceral involvement. It is unevenly found worldwide but it is endemic
in tropical and subtropical countries. Two groups of mycetoma exist with similar clinical
presentation; eumycetoma due to true fungi, and actinomycetoma due to aerobic bacteria
from actinomycomycetes species. Mycetoma is difficult to treat and can lead to serious
sequelae including disability, deformity and even death, so early diagnosis and treatment
can elicit good results. The diagnosis is made based on a clinical picture of a triad of
painless tumefaction, draining sinuses and granules of the causative micro-organism
along with direct microscopic examination and histological study. It is very important
to distinguish between actinomycetoma and eumycetoma for selecting the therapy.
Actinomycetomas generally respond well to antimicrobials compared with eumycetomas,
which respond poorly and need a combination of medical and surgical therapy. Bone
involvement makes treatment more difficult, keeping surgical amputation as the only
choice of treatment. Despite the possibility of a cure with medical treatment alone,
treatment failure may occur even with long-term therapy, which necessitates adding
surgical intervention to achieve cure. We report a case of gluteal actinomycetoma in an
Omani man, treated successfully by combined medical treatment and surgical excision
with graft reconstruction after failure of different regimens of antimicrobials.
