Combined welsh and modified ramam regimen in the management of an actinomycetoma patient with sulfonamide drug sensitivity

Mycetoma is a chronic, suppurative granulomatous infection which has been declared as a neglected tropical disease by the World Health Organization. The clinical manifestations include the classical triad of swelling, sinus tracts, and discharge. It is of two types, eumycetoma (true fungi) or actinomycetoma (filamentous aerobic bacteria), and is more prevalent in tropical and subtropical areas. Here is a case report of mycetoma patient who presented to the outpatient department with the classical triad of symptoms. Histopathological confirmation of actinomycetoma was made and started with Welsh regimen. As he developed drug sensitivity to cotrimoxazole, it was stopped. He was continued with amikacin as per Welsh regimen along with doxycycline 100 mg twice daily instead of cotrimoxazole for 3 cycles with complete cure. Regular monitoring with hemogram, renal function tests, and audiogram were done before and after each cycle. There are multiple reports of treatment of actinomycetoma by various antibiotics such as cotrimoxazole, dapsone, streptomycin, trimethoprim, rifampicin, and amoxicillin–clavulanic acid combination. This case report highlights the importance of individualization of treatment regimen based on the clinical scenario.