title: Cutaneous granular bacteriosis, a rarely diagnosed infection of the head and the neck.
abstract: A young man presented with a large multilobulated and mutilating tumour of the scalp, which had been relapsing for years. Histological examination of a biopsy from the lesion revealed chronic inflammation with granulation tissue and presence of granules with eosinophilic periphery, which was positive for Gram, Grocott and periodic-acid-Schiff stains. A large excision was performed. Cultures grew Staphylococcus aureus. The patient was treated with penicillin G, but 4 weeks after the start of treatment, new small nodules appeared over the same area. All these new nodules disappeared within 2 weeks the addition of clindamycin and cotrimoxazole. This triple antibiotic treatment was carried on for 18 months, and the patient remained disease-free after a follow-up of 4 years. Although the lesions were clinically and histologically suggestive of actinomycosis, culture revealed that they were caused by a completely different organism. We suggest grouping such lesions under a single term "granular bacteriosis" and combining surgery with broad-spectrum antibiotics covering Actinomyces species and botryomycosis-causing organisms (mainly Staphylococcus).
authors.affiliation: Department of Dermatology, Saint-Joseph University, Beirut, Lebanon. rtomb@usj.edu.lb
authors.forename: R R
authors.initials: RR
authors.lastname: Tomb
authors.forename: F
authors.initials: F
authors.lastname: Stephan
authors.forename: A
authors.initials: A
authors.lastname: Haddad
authors.forename: J
authors.initials: J
authors.lastname: Choucair
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D012008:Recurrence; D012536:Scalp Dermatoses / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination