Cutaneous botryomycosis L98.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 14.06.2022

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Botryomycosis; Botryomykom; cutaneous botryomycosis; Cutaneous botryomycosis

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Bollinger, 1870; Spitz, 1903; Opie, 1913

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Rare, chronic, bacterial infectious disease, often caused by staphylococci, but also by other bacteria, clinically and histologically similar to actinomycosis, originally misinterpreted as cutaneous mycosis (pseudomycosis), which can primarily affect the skin, the adjacent organ systems, but also all other organs as "visceral botryomycosis". Systemic botryomycosis is mainly expected in immunocompetent patients (Sirka CS et al. 2019).

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Cutaneous and visceral forms of botryomycosis.

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Very rare. Common in immunosuppressed patients: HIV infection, diabetes mellitus, immunosuppressive therapy, cystic fibrosis, osteomyelitis, dental or jaw infections.

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Bacterial infections most commonly caused by S. aureus (40%), less commonly by P. aeruginosa (20%), Bacillus spp., Proteus spp., E. coli, Streptococcus spp., Neisseria.

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Cutaneous (> 60%); cutaneous and visceral (approx. 20%); visceral (< 20%).

Clinical features
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Skin: The skin is affected as pure cutaneous botryomycosis in the vast majority of known cases of botryomycosis (about 60%). In immunocompromised patients, only a localized process is generally present.

A superficial skin lesion often acts as a portal of entry.

Clinically, localized, disseminated or even sporotrichoid distributed, therapy-resistant, chronically persistent or also chronically progressive, little painful, mostly ulcerated, red papules, deep-lying abscessing nodules (which always have to be incised again) or inflammatory plaques appear. Especially in immunocompetent patients (acquired or hereditary immunodeficiency), generalized, untreated even fatal clinical pictures with extensive swellings, as well as sporotrichoid nodules and ulcerations may occur.

The infection tends to progress to invasion of subcutaneous systems (fascia, muscle, or bone). If left untreated, a continuous, chronically abscessing, inflammatory, indurating process is the result (see Fig.).

Systemic involvement: Involvement of lungs, brain, peritoneum, prostate, liver, kidneys.

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Grape-shaped eosinophilic granules in the area of the epidermis. Occasionally epidermal inclusion cysts or microabscesses.

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Clinic, histology, antibiogram after smear collection from skin florescences. Exclusion of deep mycoses.

Differential diagnosis
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Therapy of an underlying underlying disease. Often an antibiotic systemic therapy of several weeks is required.

External therapy
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Possibly antiseptic solutions such as polihexanide (Seraderm), diluted potassium permanganate solution (light pink), quinolinol solution(e.g. Chinosol 1:1000), R042.

Internal therapy
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Antibiosis against staphylogenic pathogens with Flucloxacillin (e.g. Staphylex Kps.) 3 g/day (max. 12 g/day) in 3 ED p.o. or Dicloxacillin (e.g. InfectoStaph) 2-3 g/day p.o. in 4 ED.

Successes are also reported with Sulfamethoxazole/Trimethoprim (e.g. Cotrimoxazole 2 times/day 2 Tbl. p.o.).

As soon as possible antibiosis after antibiogram.

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The term "botryomycosis" is derived from the Greek words "botrys" for grapes and myces for mushrooms.

Indicative of the aetiology of the disease are the eosinophilic granulated drusen (as in actinomycosis) in the abscesses, a phenomenon which according to the first describers is called"Splendore-Hoeppli phenomenon".

Case report(s)
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The 72-year-old patient was known to have severe atopic eczema since childhood, which required constant large-scale treatment with glucocorticoid externals. Several times inpatient treatments were necessary - because of eczema herpeticatum, because of recurrent pyoderma and because of the repeatedly exacerbated severe atopic eczema.

Seti about 4 years, little symptomatic, hardly painful, red papules and pustules formed on the left thigh, also deep-seated abscessing nodules, which had to be cleaved again and again.

Cultures obtained from pus on several occasions always yielded evidence of Staphylococcus aureus. Mycological examinations were always negative. Only histological examination of a deep excision biopsy resulted in the diagnosis of "botrymocosis" (evidence of eosinophilic granules in a central abscess section). After consistent 8-week therapy with flucloxacillin, the process healed.

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Last updated on: 14.06.2022