Mycetoma is endemic in many developing countries. We report here a case of actinomycetoma in a 60 year old male, farmer by occupation, patient gave history of bare foot walking and patient recalls history of trivial trauma over legs who presented with diffuse multiple plaques studded with discharging sinuses and surrounding oedema over the medial aspect of left ankle. Patient is a known case of uncontrolled T2DM on insulin and altered renal parameters that posed as a therapeutic challenge where welsh/modified welsh regimen could not be planned in this patient. Based on clinical and histological picture and Pus & culture sensitivity reports patient was treated with oral Sulfamethoxazole 800mg with Trimethoprim 160mg two tablets daily and oral amoxicillin with clavulanic acid 1gm twice daily for 4months showed marked improvement, lesions dried up after four months and healed with post inflammatory hyperpigmentation & scars. This case is presented to demonstrate how early disease diagnosis and prompt treatment can reduce the significant morbidity associated with this devastating infection. Key words: Actinomycetoma, Suppurative granuloma, Trimethoprim-sulfamethoxazole (SMX+TMP), Amoxicillin clavulanic acid

Introduction Immunotherapy works by increasing cell mediated immunity against HPV. Some studies have shown that combining immunomodulators with different MOA can result in a synergistic effect that is slightly better than single therapy. To compare the efcacy of Intralesional measles-rubella (MR) Aim & Objectives: vaccine with oral zinc VS IL MR vaccine monotherapy in treatment of palmoplantar warts In this hospital Materials and methods: based, interventional study, 20 clinically diagnosed cases of palmoplantar warts were enrolled and randomly divided into 2 groups of 10 patients each. Group A received 0.5 ml/2 units of MR vaccine, injected into the largest wart. The dose was repeated at 2-week intervals until complete clearance or maximum of 3 doses with oral zinc for one month. Group B received only 0.5ml/2 units of MR vaccine for the same period. Follow up was every 2 weeks for 3 months after last injection. Clinical improvement assessed by physician's global assessment using visual analogue scale score. Statistical analysis done using SPSSversion21. Results: In group A complete clearance in 60%, excellent response in 30%and good response in 10% , while in group B complete clearance in 50%,excellent response in 30% and good response in 20%.The mean number of injection for complete clearance 3.6 in group A & 3.8 in group B. No recurrence in either group. Clinical improvement slightly better in group A than in group B. Conclusion: In our study we found combination of two immunomodulators for the treatment of warts is slightly better than when used individually.