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A 48-year-old woman presented with an 8-year history of recurrent, painless swellings with chronic pus discharge from her right foot after a minor injury while she was working in a paddy field. There was no visceral involvement in the form of fever, organomegaly or lymphadenopathy. She had received multiple treatment modalities including 9 months of antituberculous therapy without any relief. Examination of her right foot showed multiple painless swellings and woody induration with sinus tracts (figure 1). Pus discharge from sinus tracts revealed typical grains of 2–3 mm diameter. Tissue Gram staining showed fine branching hyphae of Actinomadura within actinomycetoma grain (figure 2). X-Ray of the foot showed destruction of metatarsal bones with multiple cavities (figure 3). The lesions have shown definite regression after 6 months of therapy with dapsone and streptomycin.
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