A farmer presents with multiple discharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is -
Multiple discharging sinuses not responding to antibiotics suggest the diagnosis of mycetoma.


Actinomycetoma may respond to antibiotic therapy. eg. combination of streptomycin and dapsone or combination of streptomycin and trimethoprim-sulfamethoxazole.
Actinomycetoma is caused by Actinomadura, Nocardia and Streptomyces.
Eumycetoma rarely responds to antibiotics, some cases caused by madurella mycetoma have appeared to respond to ketoconazole or itraconazole.