Actinomycetoma in a patient with pre-existing sensorineural hearing loss: a linezolid-based treatment paradigm

BMJ Case Rep. 2024 Apr 24;17(4):e258686. doi: 10.1136/bcr-2023-258686.

Abstract

Mycetoma is a chronic granulomatous infectious disease with a triad of subcutaneous swelling, discharging sinuses and the presence of granules. The infection may occur following minor trauma or penetrating thorn injury. We report a case of a man in his 40s with a history of thorn prick 9 years ago, followed by the formation of painless discharging sinuses on the right foot for the past 2 years. Clinical, local epidemiological, histopathological examination and Gram stain confirmed the diagnosis of actinomycetoma. Prior to initiating the Welsh regimen, a pretreatment assessment of the patient's auditory function was conducted through pure tone audiometry, indicating the existence of pre-existing high-frequency bilateral sensorineural hearing loss. The patient was treated with linezolid as an alternative to amikacin, at a dosage of 600 mg two times per day, leading to complete resolution within 3 weeks. This underscores linezolid's efficacy as a safe and cost-effective alternative for actinomycetoma, without causing ototoxic side effects.

Keywords: Dermatology; Pharmacology and therapeutics; Skin.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Hearing Loss, Sensorineural* / diagnosis
  • Hearing Loss, Sensorineural* / drug therapy
  • Humans
  • Linezolid* / administration & dosage
  • Linezolid* / adverse effects
  • Linezolid* / therapeutic use
  • Male
  • Mycetoma* / diagnosis
  • Mycetoma* / drug therapy
  • Treatment Outcome

Substances

  • Linezolid
  • Anti-Bacterial Agents