A Diabetic Man with a Palpable Abdominal Wall Mass

Mackowiak, Philip A.; Liu, K.-L.; Lee, T.-C.; Lin, Wanping; Lai, I-Rue

doi:10.1086/501467

Cited by 1 publication

(6 citation statements)

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“…The characteristic histopathologic feature of botryomy-cosis is the presence of granules composed of bacterial cocci (in cases of S aureus) embedded in a unique radiating eosinophilic debris matrix demonstrating characteristics of Splendore-Hoeppli phenomenon. 3 The clinical and histopathologic differential diagnosis of botryomycosis includes actinomycetoma and eumycetoma. The granules observed in botryomycosis can resemble the granules commonly seen in these entities; however, histopathologic features and culture can help differentiate.…”

Section: Discussionmentioning

confidence: 99%

“…For cases of S aureus botryomycosis, antibiotic therapy with oral trimethoprimsulfamethoxazole or oral clindamycin can be used based on bacterial culture results and sensitivity. 3,7 The duration of antibiotic therapy can vary from weeks to months depending on the extent of the infection. Surgical excision also may be required to remove the localized infection, 3 although this can be complicated for extensive cases.…”

Section: Discussionmentioning

confidence: 99%

“…3,7 The duration of antibiotic therapy can vary from weeks to months depending on the extent of the infection. Surgical excision also may be required to remove the localized infection, 3 although this can be complicated for extensive cases. In our patient, the lesion was surgically removed with the biopsy and healed well.…”

Section: Discussionmentioning

confidence: 99%

“…Although the bacterial nature of botryomycosis was established in 1919 from a lesion in a horse, the underlying etiology of this slow-progressing infection still remains largely unknown. Botryomycosis most commonly occurs in the setting of immunosuppression, such as in HIV, diabetes, cystic fibrosis, and in cases of foreign-body–related masses in the lung, abdomen, or other visceral organs. The most common organism observed in botryomycosis is S aureus , but other bacteria also have been reported including Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris , and Streptococcus species .…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis requires histopathologic and/or microbiologic confirmation. The characteristic histopathologic feature of botryomycosis is the presence of granules composed of bacterial cocci (in cases of S aureus ) embedded in a unique radiating eosinophilic debris matrix demonstrating characteristics of Splendore-Hoeppli phenomenon …”

Section: Discussionmentioning

confidence: 99%

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Painful Papulonodule on the Foot of a Patient With Human Immunodeficiency Virus

2017

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A man in his 50s with diagnoses of human immunodeficiency virus (HIV) infection, hepatitis B, and latent tuberculosis presented with a slow-growing nodule on the left foot. The lesion started 1 year prior as a tender red nodule on the medial aspect of his first metatarsophalangeal joint, which would enlarge and become painful approximately once a month (Figure , A). The patient reported that with manipulation, a clear-to-yellow material drained from the lesion. The patient denied any purulent drainage, additional skin lesions, fever, chills, or other systemic symptoms. His medications included efavirenz-emtricitabine-tenofovir disoproxil fumarate for his HIV, with the most recent absolute CD4-positive cell count of 341 cells/mm 3 (reference range, 263-2045 cells/mm 3 ), and recent completion of an 8-month course of isoniazid treatment after being exposed to tuberculosis. Physical examination demonstrated an erythematous papulonodule without warmth or drainage on the dorsal left great toe. No lymphadenopathy was appreciated. A punch biopsy was performed (Figure , B, C, and D) to help establish the diagnosis. H&E, original magnification ×4 B Clinical photograph A H&E, original magnification ×40 C Gram stain, original magnification ×40 D Figure. A, Clinical photograph of slow-growing red papulonodule on the left toe dorsal foot. B, Biopsy with hematoxylin-eosin (H&E) staining demonstrating acral skin with acute and chronic inflammation within the deep dermis. C, Higher magnification highlights eosinophilic material surrounding small cocci. D, Gram staining of the biopsy supported the diagnosis. WHAT IS YOUR DIAGNOSIS? A. Botryomycosis B. Cutaneous tuberculosis C. Digital mucous cyst D. Foreign-body reaction Clinical Review & Education

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Section: Discussionmentioning

confidence: 99%