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.
Madurella
Actinomycetoma
Nocardia
Sporothrix