Primary actinomycotic osteomyelitis of metacarpal bones managed successfully with surgical debridement and Welsh regimen

Mycetoma of the hand is a chronic granulomatous disease seen in the tropics and subtropical regions, mainly affecting the skin and subcutaneous tissue of the foot. Primary actinomycotic osteomyelitis involving the metacarpals is rarely reported in the literature. The conventional treatment for actinomycosis has been high-dose penicillin. We report a case of chronic osteomyelitis in the metacarpals of the hand caused by actinomycetes in a woman in her 40s. She underwent surgical intervention in the form of wound debridement and curettage, followed by a 6-month course of Welsh regimen after a biopsy confirmed the diagnosis of actinomycotic osteomyelitis. This case report underscores the importance of recognising primary actinomycosis as a potential cause of chronic osteomyelitis at unusual sites and highlights the efficacy of combined surgical debridement, biopsy and adequate antibiotic management in consultation with infectious disease specialists in achieving good outcomes.