<prompt> A farmer presents with multiple discharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is -MadurellaActinomycetomaNocardiaSporothrix  <response>: 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. 