Indian Journal of Dermatology
E–CASE REPORT
Year
: 2013  |  Volume : 58  |  Issue : 5  |  Page : 406-

Botryomycosis


B Devi, B Behera, ML Dash, MR Puhan, SS Pattnaik, S Patro 
 Department of Skin and VD, SCB Medical College, Cuttack, India

Correspondence Address:
B Devi
Department of Skin and VD, B 175, Pragyan Bihar, Baramunda, BBSR - 751 003, Odisha
India

Abstract

Botryomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. Main etiological agent is Staphylococcus aureus and less commonly Pseudomonas spp., Escherichia coli, Proteus spp., Streptococcus spp. We here report a case of 32-year-old male with polymicrobial botryomycosis on forehead and on frontal scalp. Culture from lesions revealed growth of S. aureus initially. Partial resolution was achieved with cefadroxyl and clavulanic acid, rifampicin, and linezolid. Subsequent repeat culture revealed E. coli sensitive to netilmycin. Slow and steady resolution was achieved with surgical debridement and combination therapy of injectable netilmycin and oral sufomethoxazole and trimethoprim for a prolonged period.



How to cite this article:
Devi B, Behera B, Dash M L, Puhan M R, Pattnaik S S, Patro S. Botryomycosis.Indian J Dermatol 2013;58:406-406


How to cite this URL:
Devi B, Behera B, Dash M L, Puhan M R, Pattnaik S S, Patro S. Botryomycosis. Indian J Dermatol [serial online] 2013 [cited 2020 Aug 13 ];58:406-406
Available from: http://www.e-ijd.org/text.asp?2013/58/5/406/117322


Full Text

 Introduction



Botryomycosis (or bacterial pseudomycosis or pyoderma vegetans) is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. [1] Most common causative bacteria is Staphylococcus aureus and occasionally Pseudomonas spp., Escherichia coli, Proteus spp., and Streptococcus spp. [2]

 Case Report



A 32-year-young man presented with 1 year history of multiple erythematous fluctuant skin lesions, most of which were discharging purulent material. The lesions were located over forehead and frontal scalp [Figure 1]. He had a history of road traffic accident 2 years back with trauma over forehead. Local cutaneous examination revealed nodular, cystic, granulomatous, indurated, and tender lesions. Vital signs were normal. Systemic examination did not reveal anything significant to the case.{Figure 1}

No reports suggestive of immunosuppression or diabetes mellitus were noted. On culturing, the isolate grew as a golden-yellow pigmented, opaque colony that was later diagnosed as S. aureus by Gram staining, and catalase and coagulase tests. Ziehl - Nelssen staining, KOH preparation, and fungal culture were negative. Skull and chest X-ray revealed no abnormality. Biopsy revealed features of botryomycosis.

As per sensitivity reports, the treatment was modified to oral cefadroxyl and clavulanic acid (500 mg, twice daily) for 10 days along with rifampicin (600 mg, once daily) for first 2 weeks. As the patient developed new lesions, repeat culture was tested to reveal growth of E. coli. Based on the sensitivity reports, the patient was treated with injectable netilmycin (300 mg/3 ml, once daily) for 15 days with oral sulfomethoxazole-trimethoprim (double strength, twice daily). One session of surgical debridement was performed for the solitary larger granulomatous mass, non-responsive to treatment. Slow and steady resolution was achieved during 2 months of the patient's hospitalization. Presently, patient is continuing oral sulfomethoxazole-trimethoprim (double strength) and is on regular follow-up with remarkable improvement [Figure 2].{Figure 2}

 Discussion



Botryomycosis may present in cutaneous or visceral forms. Cutaneous form is a chronic persistent condition that presents with chronic, suppurative, and granulomatous skin lesions as in our patient. It may be preceded by trauma. [2] Most cases present with nodules, abscesses, and sinuses with purulent discharge (similar to that in our patient). Visceral form is usually with pulmonary involvement, [3] which is associated with cystic fibrosis and reaches skin forming sinuses and irregular masses; this was ruled out in our patient by chest x-ray. Multi-bacterial etiology of botryomycosis in a single patient is rarely detected. Moreover, the involvement of head and neck is quite rare in comparison to extremities, as reported by various authors. [4],[5] The main differential diagnoses of botryomycosis are exogenous actinomycosis and eumycetoma, which clinically present enlarged affected area, fistulas, and drainage of granules, differing with regard to etiology, location, and consistency of the lesions. [6] This case has been presented due to its rarity, unusual site of involvement, and response to netilimycin and co-trimoxazole.

References

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3Motswaledi H, Makama JZ, Khan N. Botryomycosis: A case report. SA Journal of Radiology 2006;10:14-5.
4Ellerbe DM, Parsons DS, Cook PR. Botryomycosis: Improved therapy for a difficult situation. Int J Pediatr Otorhinolaryngol 1997;41:363-9.
5Yencha MW, Walker CW, Karakla DW, Simko EJ. Cutaneous botryomycosis of the cervicofacial region. Head Neck 2001;23:594-8.
6Coelho WS, Diniz LM, Souza Filho JB. Cutaneous botryomycosis - Case report. An Bras Dermatol. 2009;84:396-9.