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Article Details

Clinical Image

Volume 5, Issue 5 (May Issue)

Cutaneous Botryomycosis in an Immunocompromised Patient

Mona T. Yazdi1,2* and Samuel A. Lee2

1Dartmouth-Hitchcock Medical Center, Lebanon, NH

2White River Junction Veterans Affairs, White River Junction, VT

*Corresponding author: Mona T. Yazdi, Infectious Diseases, Dartmouth-Hitchcock Medical Center, Lebanon, NH. E-mail:

Received: March 03, 2023; Accepted: March 14, 2023; Published: April 05, 2023

Citation: Yazdi MT, Lee SA. Cutaneous Botryomycosis in an Immunocompromised Patient. Clin Image Case Rep J. 2023; 5(3): 313.

Cutaneous Botryomycosis in an Immunocompromised Patient

A 76-year-old man with a history of orthotopic liver transplant presented with a 3-week history of erythematous, violaceous nodules on his anterior and posterior right leg (Panel A). Biopsies showed questionable yeast-like organisms on GMS stain, but not on PAS, Giemsa, or acid-fast stains (Panel B). A tissue biopsy sample grew methicillin-resistant Staphylococcus aureus, and the diagnosis of cutaneous botryomycosis was made by histopathology.

Botryomycosis presents as single to multiple nonpainful, firm nodules with or without draining fistulae that develop slowly and are typically caused by Staphylococcus species. The slow growth is thought to be due to a balance between the host’s immune system and the bacteria’s decreased pathogenicity. In addition to fungal and mycobacterial infections, botryomycosis should be considered in the differential diagnosis for immunocompromised patients presenting with cutaneous nodules. A 4-week course of doxycycline and local wound care led to complete resolution of the patient’s lesions.