A 10-year-old boy presented with a 2- to 3-year history of painful nodules on his left foot (Figure 1) and swelling of the left inguinal area (Figure 2 and Figure 3). A swollen foot, nodules, and enlarged regional lymphadenopathy were seen on examination.

Histologic examination revealed granulomatous inflammation with granules and long, branching filaments. Results were gram positive and periodic acid-Schiff negative, in keeping with actinomycosis. Tissue culture also confirmed the diagnosis of actinomycosis.

Cotrimoxazole and dapsone were commenced, and the child is responding well to therapy.