A rare case of Streptomyces fradiae hand actinomycetoma

Actinomycetoma is a rare, chronic, and progressive bacterial and fungal infection that affects subcutaneous tissues, fascia, and bones. This a case of a 27-year-old Sudanese male, shepherd, with a mycetoma lesion in the right hand caused by Streptomyces fradiae. He presented with swelling and deformity of the hand, and subsequent imaging showed soft tissue swelling, deep infiltration of the hand and sinus formation. A skin biopsy of the lesion confirmed the diagnosis of actinomycetoma, and the patient was treated with ceftriaxone IV for 14 days followed by oral amoxicillin clavulanic acid for a total of 3 months. Surgical excision followed by reconstruction of the hand was performed. Histopathological examination of the excised tissue showed abscess formation around colonies of actinomyces. The patient had significant clinical recovery with no recurrence of the infection. Streptomyces fradiae is a rare causative agent of actinomycetoma, and this case highlights the importance of early diagnosis and prolonged antibiotic therapy in the management of this infection.