Unravelling <i>Nocardia</i>-induced Actinomycetoma from Central Maharashtra: Clinical Insights and Diagnostic Challenges
| Author | Apurva Damle | en |
| Author | Neelam Bhatt | en |
| Author | Shekhar N Pradhan | en |
| Author | Vasudha Abhijit Belgaumkar | en |
| Author | Bhushan Darkase | en |
| Author | Dixsha Vijaykumar Katre | en |
| Orcid | Neelam Bhatt [0009-0002-9554-4272] | en |
| Orcid | Shekhar N Pradhan [0009-0003-0496-9951] | en |
| Issued Date | 2025-09-30 | en |
| Abstract | Introduction: Actinomycetoma is a chronic infectious granulomatous disease affecting the skin and subcutaneous tissue, caused by aerobic filamentous bacteria. Actinomycetoma due to Nocardia (Gram-positive, filamentous, acid-fast bacilli) is endemic in Africa, Mexico, and South and Central America. There are only a few cases reported in the literature from Maharashtra, specifically in Mumbai, Pune, and the Vidarbha region. Nocardial actinomycetoma around the knee is a rare presentation. Herein, we report a case of a 62-year-old male agricultural worker from the central Maharashtra region. Case Presentation: A 62-year-old agricultural worker presented with multiple discharging sinuses and swelling around the right knee without granules. Discharge from multiple sinuses was subjected to microbiological investigations [10% KOH mount, Gram stain, Ziehl-Neelsen (ZN) stain]. The KOH mount was negative, while the Gram stain revealed Gram-positive filamentous bacilli. Modified ZN stain demonstrated partially acid-fast filamentous bacilli, confirming Nocardia species. Histopathological examination revealed actinomycotic colonies surrounded by epithelioid cell granulomas. Imaging showed multiple hypoechoic interconnecting tracts on local ultrasound with the characteristic ‘dot-in-circle’ sign on contrast-enhanced MRI (knee). The final diagnosis was confirmed as actinomycetoma (caused by Nocardia) based on microbiological, histopathological, and radiological investigations. Conclusions: Nocardial actinomycetoma poses a diagnostic challenge. Although Nocardia is a rare pathogen, it deserves consideration in the etiological differential diagnosis of mycetoma. Astute clinical examination with prompt laboratory evaluation can facilitate an accurate diagnosis. Early identification and timely initiation of effective therapy are crucial for achieving a favorable outcome and preventing complications. | en |
| DOI | https://doi.org/10.5812/jssc-163364 | en |
| Keyword | Central Maharashtra | en |
| Keyword | <i>Nocardia</i> | en |
| Keyword | ‘Dot-in-Circle’ Sign | en |
| Keyword | Modified Welsch Regimen | en |
| Publisher | Brieflands | en |
| Title | Unravelling <i>Nocardia</i>-induced Actinomycetoma from Central Maharashtra: Clinical Insights and Diagnostic Challenges | en |
| Type | Case Report | en |