Cutaneous botryomycosis of the cervicofacial region.
BACKGROUND
Botryomycosis is a rare, chronic, bacterial infection of insidious onset involving the integument or viscera that often mimics actinomycosis or a deep fungal infection. The pathogenesis is thought to be a symbiotic relationship between the host and the infecting organism.


METHODS
Case report of a patient with a chronic infection involving the cervicofacial region diagnosed as cutaneous botryomycosis arising from a chronic osteomyelitis of the mandible. The diagnosis was based on the chronicity of the infection along with the identification of botryomycotic (bacteria-containing) granules on histopathologic examination. Special stains excluded fungi and mycobacterium. Cultures identified the offending bacteria, and antibiotic therapy was initiated on the basis of the sensitivities, resulting in resolution of this chronic infectious process. A review of the English language literature revealed that this is the first case of cutaneous botryomycosis arising from a chronic osteomyelitis of the mandible.


RESULTS
Medical therapy proved curative at 14 months follow-up. Surgery was performed for diagnostic purposes only.


CONCLUSIONS
Botryomycosis is exceedingly rare in the head and neck, and consideration of this entity in the differential diagnosis is critical to the diagnosis. The mainstay of therapy is medical with surgery reserved for biopsy and/or excision of persistent disease. Published 2001 John Wiley & Sons, Inc.
Yencha
M W
MW
Department of Otolaryngology-Head & Surgery, Naval Hospital-Pensacola, 6000 West Highway 98, Pensacola, Florida 32512, USA. mwyencha@psa10.med.navy.mil
Walker
C W
CW
Karakla
D W
DW
Simko
E J
EJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002908:Chronic Disease; D002981:Clindamycin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D010019:Osteomyelitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011877:Radionuclide Imaging; D013207:Staphylococcal Skin Infections / Q000175:diagnosis* / Q000473:pathology; D013211:Staphylococcus aureus
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002981:Clindamycin; D002437:Cefazolin