Botryomycosis in an immunocompetent woman

Abstract

A 64-year-old woman presented at our department with a 2-month history of inflammatory papules and nodules mainly localized to the abdomen (Fig. 1). Some of these nodules showed a discharge of purulent fluid. She denied previous traumas or insect bites. Medical past history was irrelevant. HIV and HCV were negative. Patient was previously unsuccessfully treated by her assistant physician with flucloxacillin and cephradine (duration and dosages unknown). Findings from routine blood testing, including leukocytes, neutrophil count and C-reactive protein, were normal. A punch biopsy specimen from a nodule was submitted for histopathologic evaluation and another one was submitted DOI: http://dx.doi.org/10.3315/jdcr.2013.1134 29 PHOTOLETTER TO THE EDITOR AbstractBotryomycosis is a chronic, granulomatous infection of the skin, soft tissue and viscera. It is uncommon and mainly occurs in immunocompromised patients. Splendore-Hoeppli phenomenon represents an immunological host reaction to antigens of infectious and non-infectious agents.We report a case of a 64-year-old immunocompetent woman presented at our department with a 2-month history of abdominal papules and discharging nodules. She was treated with several antibiotics with no success. Skin biopsy showed granular bodies in the dermis with a Splendore-Hoeppli phenomenon. Microbiologic study isolated a Staphylococcus aureus. Patient was successfully treated 4 weeks with oral clindamycin 300 mg bid.Lack of drug penetration into the "encapsulated-like" microcolonies could explain the therapeutic challenge of this case. (J Dermatol Case Rep. 2013; 7(1): 29-30) Key words: botryomycosis, actninophytosis, Splendore-Hoeppli phenomenon Figure 1Abdominal pus discharging papules and nodules.

Case of cutaneous botryomycosis in an 8‐year‐old immunocompetent boy with a review of the published work

“…Several other cases in immunocompetent patients have been reported (Table 1). [9][10][11][12][13][14][15] We choose the articles by the following criteria: (i) the patients were immunocompetent; and (ii) the duration, the period from notice of lesion to consultation, was short (<1 year). As far as we know, there were 14 cases whose duration was long (≥1 year).…”

Subcutaneous Granulomatous Inflammation due to Basidiobolomycosis: Case Reports of 3 Patients in Buruli Ulcer Endemic Areas in Benin

“…Importantly, BU differs from basidiobolomycosis in etiology and management. The Splendore-Hoeppli phenomenon itself is not specific for basidiobolomycosis [ 18 ] and can also be observed in other infections, such as botryomycosis [ 23 ] bronchocentric granulomatosis due to Aspergillus [ 24 ] mycetoma [ 25 ] and Pityrosporum folliculitis skin infection [ 26 ], although the combination of the clinical presentation, the Splendore-Hoeppli phenomenon, and septate hyphae suggests basidiobolomycosis. In addition to a predilection for lungs rather than the subcutis, Aspergillus can be recognized by septate hyphae that branch at 45° angles and by vascular invasion, while mycetoma produces grains and has a very distinct clinical presentation from basidiobolomycosis.…”