Successful Management of Progressive Mycetoma Affecting the Head and Neck

Mycetoma is a chronic, destructive subcutaneous infection of fungal (eumycetoma) or bacterial (actinomycetoma) origin; predominantly affecting the extremities. Head and neck involvement is exceedingly rare, posing significant diagnostic and therapeutic challenges. Intractable cases are more difficult to manage, requiring alternative treatment strategies. We report the case of a 14-year-old girl with a 3-year history of ulcerating sinuses and nodules progressively spreading from the scalp and neck; to the upper back. Prior treatments with various antibiotics and antifungals provided no improvement. Histopathological analysis revealed neutrophilic inflammation and grains confirmed to be Nocardia species on Ziehl Nielsen staining. A combination of rifampicin and trimethoprim-sulfamethoxazole was initiated; resulting in remarkable clinical improvement and resolution of symptoms over 24 weeks. This case report demonstrates the efficacy of combining rifampicin and trimethoprim-sulfamethoxazole in managing rare, progressive case of head and neck mycetoma, especially where toxicity from established treatment regimen is feared. Future research should investigate optimal treatment durations and explore adjunctive therapies for mycetoma, particularly in resource-limited settings.