A Rare Case of Actinomycetoma In Pregnancy: Effective Treatment with the Combination of Amoxicillin-Clavulanic Acid.

Introduction: Actinomycetoma is a chronic granulomatous of the skin and subcutaneous tissue caused by filamentous bacterial infection. In pregnancy, this disease is associated with poor clinical outcomes and often unresponsive to standard therapy. Although actinomycetoma is primarily treated with antibiotics, nevertheless, many recommended antibiotics cannot be used during pregnancy due to the potential for fetal harm. Report of actinomycetoma in pregnancy are infrequent. The management of mycetoma in pregnancy requires special attention in various aspects, particularly regarding the safety of the mother and fetus.

Case presentation: A 21-year-old pregnant woman, gestational age of 31-32 weeks, presented with tumefaction, multiple nodules, and sinuses that secreting serosanguinolenta exudate on the right knee. The patient was diagnosed as actinomycetoma according to clinical manifestations of tumefaction, sinuses, and the appearance of grain from direct microscopic and histologic examination. Bacterial culture revealed the growth of Actinomycetes colony. The patient received amoxicillin-clavulanic acid 625 mg thrice daily. Clinical improvements were observed after the fourth week of therapy. There was no adverse event reported during the treatment period nor the follow up period.

Conclusion: Actinomycetoma in pregnancy has limitation in the choice of therapy. The combination of amoxicillin-clavulanic acid can be considered as an effective and relatively safe therapy for pregnancy with actinomycetoma.