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Botryomycosis - A rare case report.

Byline: Masuma P Bhengra, Anand Kumar, Shweta Komal, Pradeep Kumar and Vatsala Rai

Abstract

Botryomycosis also known as bacterial pseudomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely the viscera. Staphylococcus aureus is the most common etiological agent, however other species likePseudomonas aeruginosa, Escherichia coli, Proteus vulgaris, Bacteroides, Actinobacillus sp. mayalso cause the disease. The clinical picture of botryomycosis closely resembles scrofuloderma, mycetoma or actinomycosis. Henceforth, proper diagnosis with appropiate treatment is thus needed.

Key words: Botryomycosis, granulomatous, Staphylococcus aureus.

Introduction

The name Botryomycosis refers to Greek word botryomeaning grapes; grape-like granules and Greek word mykesmeaning fungus; mistakenly impliedto fungaletiology.1 It was originally discovered by Otto Bollingerin 1870, and its name was coined by Sebastiano Rivolta in 1884. In 1919 the bacterial origin of the infection was discovered. On reviewing the Indian literature, very few cases of botryomycosis have been documented. Herein, we here report a case of botryomycosis which progressed slowly but responded very well toantibiotics.

Case report

A 33-year-old farmer presented with multiple painful nodular lesions with draining sinuses, most of which had foul smelling discharge.Such lesions were present over his left upper chest and left shoulder including upper 2/3rd of his arm for last 2 years(Figure 1 and2).He gave a history of preceding trauma.The lesion started as papule over left upper chest which gradually developed into a nodular swelling,increased in size, and formed a discharging sinus. Later slowly, in few months many more nodules and discharging sinuses appeared around this lesion. There was no history of any chronic illness in the past. On local examination, the left shoulder region was swollen with numerous elevated, well-demarcated, small and large nodular lesions and many discharging sinuses were present.Most of the sinus openings were inflamed and blocked with dried pus (some with oozing lesions). Tenderness was present.

Discharge was yellowish, purulent and foul smelling. Routine hematological and urine examinations were normal. HIV and RPR tests were nonreactive. Radiological study of chest and left shoulder joint did not reveal any abnormality in the bones. Pus when soaked with normal saline dressings did not show any granules. Culture on blood agar showed abundant growth of golden-yellow colonies of staphylococcus(Figure 3).Gram stain, positive catalase test and mannitol fermentation test confirmed it to beStaphylococcus aureus.Other tests like Ziehl-Neelsen stain, KOH mount and fungal cultures were negative.Biopsy was done which wasconsistent with the findings of botryomycosis. Pus was found to be sensitive for gentamycin,amikacin, ceftriaxone and piperacillin-tazobactam but resistant to ciprofloxacin, cefixime and ampicillin.

The patient responded very well to piperacillin-tazobactam and gentamicin with significant reduction in swelling and decrease in number of nodules in a month time(Figure 4 and 5).The patient was regularly followed up.

Discussion

Botryomycosis may present as two forms. Primary cutaneous form accounts 75% of the cases; while the visceral form whichrarely occurs,mainly affects the lung.2Being a farmer by occupation, there was significant history of preceding trauma. Diabetes mellitus and HIV infection could also be other predisposing factors.3,4The clinical picture of botryomycosis closely resembles other diseases causing fistula; such as scrofuloderma, actinomycosis, actinomycetoma, eumycetoma and atypical mycobacterial infections. Proper evaluation of the disease with its etiological factors is, henceforth needed. Appropriate antibiotics after culture sensitivity testsand sometimes surgical resectionalways givepromising results.

Conclusion

Botryomycosis is a rare pyogenic disease with polymicrobial etiology; Staphylococcus aureus is the most commonest one.5,6The disease responded very well to antibiotics without surgical intervention. We reported this case for its rare incidence and probably the first to be seen in Jharkhand state.

References

1. Inamdar CA, Nagalotimath SJ. Botryomycosis. Indian J Dermatol Venereol Leprol. 1994;60:108-9.

2. Francisco GB, Roberto A, Daniel AS. Actinomycosis, nocardiosis and actinomycetoma.Fitzpatrick's Dermatology in General Medicine, 8 edition.New York: McGraw-Hill; 2012. P. 2251-2.

3. Roberts SOB, Highet AS. Bacterial infections. In: Rook AJ, Wilkinson DS, Ebling FJG, et al., eds Textbook of Dermatology, London: Blackwell Scientific Publications; 1988. P. 788-9.

4. Coelho WS, Diniz LM, Souza Filho JB. Cutaneous botryomycosis - Case report. AnBras Dermatol.2009;84:396-9.

5. Kadyan RS. Botryomycosis -2 case reports. VII International Congress of Dermatology, New Delhi, India, 1994 (Book of Abstracts).

6. Aronstain NE. Human botryomycosis with case report. Indian J Dermatol. 1936;2:39. (Quoted in IJDVL cumulative index, supplement, 1994; 601:10).
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Publication:Journal of Pakistan Association of Dermatologists
Article Type:Case study
Geographic Code:9PAKI
Date:Jun 30, 2016
Words:793
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