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Sudden Onset of Multiple Painful Erythematous Papules and Pustules—Diagnosis
Arch Dermatol. 2003;139:93-98.
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Diagnosis: Botryomycosis.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
A skin biopsy specimen from the right forearm revealed superficial ulceration, with an intense inflammatory infiltrate with mycetomalike granules clustered in the middle to superficial dermis. These hyaline-appearing clusters demonstrated the Splendore-Hoeppli phenomenon. Gram staining confirmed gram-positive cocci in a cluster resembling the "grain" seen in mycetoma (Figure 4).
Figure appears in full text version.
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Nafcillin sodium was intravenously administered for 42 days. The cutaneous lesions healed fully during the hospital course. The size of the brain abscess decreased markedly, and the patient had a full neurologic recovery.
DISCUSSION
Botryomycosis is a rare suppurative bacterial infection that often is mistaken clinically and histologically for a fungal infection. It is characterized by a suppurative and, occasionally, granulomatous inflammatory reaction to a bacterial infection. The most common organism cultured from lesions of botryomycosis is Staphylococcus aureus.1 However, Proteus species, Pseudomonas aeruginosa, Bacillus species, Actinobacillus lignieresii,  -hemolytic streptococci, Corynebacterium species, Propionibacterium acnes, Neisseria . . . [Full Text of this Article]
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Arch Dermatol. 2003;139(1):93-98.
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