A recent immigrant from rural Brazil presents with a swollen face and extremely poor dental hygiene, including loss of an adult tooth, which appears to be the focus of the current infection. There are two open ulcers on the outside of the swollen cheek. Small yellow ''grains'' are seen in one of the ulcers. Gram stain shows purple-staining fine filaments. What is the most likely disease?

H/O-two open ulcers on the outside of the swollen cheek and Small yellow ''grains'' which are gram positive point towards mycetoma caused by Actinomyces . The disease syndrome is lumpy jaw, which is a form of mycetoma. , a bacterial infection caused by Actinomyces pa of the gingival crevices flora. Actinomyces is a Gram-positive anaerobe that is not acid fast. Eumycotic mycetoma- caused by madurella which are not gram positive , grain contents show fungal hyphae Chromomycosis- causes veruccous lesion over body Sporotrichosis- cause multiple ulcers along lymphtics after thorn prick.