A patient with a complaint of multiple draining sinuses on the left hand that is non-functional as well. Physical examination of the hands showed the left hand fixed in extension with no appreciable range of motion seen at the wrist and finger joints. It also showed an enlargement of the left hand, described to be elephantiatic-type with fusiform swelling of the ring and index finger, with multiple draining sinuses associated with non foul smelling whitish to yellowish discharges on the volar and dorsal surface of the hand and wrist area.
STUDY DESIGN: Case Report
STUDY SETTING: Jose R. Reyes Memorial Medical Center
STUDY POPULATION: 27-year old male
Diagnosis is established by histology and cultivation of the microorganism. Therefore the necessity of good biopsy specimens taken for microscopic, mycologic, and bacteriologic examination and for culture can be overemphasized.
We conclude that mycetoma should always be included in the differential diagnosis of chronic purulent processes, particularly if they are not susceptible to the method of treatment chosen, whether it be chemotherapy or surgical treatment or a combination of both. Determination of the possible causative agent of the Actinomycetoma is needed for proper medical management to be effective. However, special procedures are needed to arrive at a definitive causative agent, which was unavailable in our setting, where question of salvage over amputation of the extremity is deemed debatable. Increased awareness of actinomycosis, is required in the differential diagnosis of any subacute or chronic inflammatory lesion involving soft tissues and progressing to osteomyelitis in the hand.