Actinomycosis caused by Actinomyces species is a chronic, suppurative, and progressive infection. Primary cutaneous actinomycosis is very rare, and the diagnosis requires a high index of clinical suspicion. Cultures are often negative for bacteria in the best of the clinical setups. We present a 30-year-old male patient with primary cutaneous actinomycosis of the left anterior abdomen with secondary involvement of the hip bone. The discharging grains were crushed, and a classic ray fungus was seen under the microscope. Staphylococcus aureus was detected as a copathogen, and it was probably responsible for resistance to common antibiotics such as ampicillin, doxycycline, and rifampicin alone. The involvement of the underlying bone required aggressive measures, and we treated it as leprosy. He was treated effectively with 600-mg rifampicin and 100-mg dapsone daily. According to the best of our knowledge, this is the first case report of primary cutaneous actinomycosis with secondary bony involvement. Actinomycosis spreads in a slow, progressive manner, ignoring tissue planes, the sinus tracts extending to the skin, adjacent organs, and bones. We report the first case of primary cutaneous actinomycosis with secondary bony involvement. Involvement of underlying bone led us to treat aggressively with 600-mg rifampicin and 100-mg dapsone daily.