Staphylococcus aureus causing primary foot botryomycosis mimicking actinomycetoma: a case report from Sudan

Int J Infect Dis. 2022 Nov:124:224-226. doi: 10.1016/j.ijid.2022.10.010. Epub 2022 Oct 12.


Objectives: Botryomycosis is a rare chronic granulomatous inflammatory disease of bacterial origin. Two forms of the disease exist; the cutaneous and the visceral form. The subcutaneous form mimics actinomycetoma clinically and histologically; however, the treatment is different. In this communication, we report on a Sudanese male patient who presented with foot botryomycosis.

Design: Case report.

Results: The patient was initially diagnosed with actinomycetoma by the presence of Streptomyces somaliensis like-grains in the histological slides. The patient was treated with a combination of co-trimoxazole and amikacin sulfate and shifted after 1 year to co-trimoxazole, amoxicillin, and clavulanic acid. Despite treatment, the infection progressed, and the bone was invaded. The infected limb was amputated. The histopathological report of the surgical biopsy showed gram-positive cocci inside the grain. The 16S sequence identified these cocci as Staphylococcus aureus.

Conclusion: This is the first reported botryomycosis case from Sudan, and it highlights why molecular identification is vital in diagnosis.

Keywords: Actinomycetoma; Botryomycosis; Diagnosis; Mycetoma; Staphylococcus aureus; Sudan.

Publication types

  • Case Reports

MeSH terms

  • Humans
  • Male
  • Mycetoma* / diagnosis
  • Mycetoma* / drug therapy
  • Mycetoma* / microbiology
  • Staphylococcal Infections* / diagnosis
  • Staphylococcus aureus
  • Sudan
  • Trimethoprim, Sulfamethoxazole Drug Combination


  • Trimethoprim, Sulfamethoxazole Drug Combination