title: [Cutaneous granular bacteriosis occurring in Staphylococcus aureus septicaemia].
abstract: BACKGROUND
  Herein we report a case of cutaneous granular bacteriosis, with discussion of the nosological setting of this entity based upon the clinical and histological findings.
  
  
  METHODS
  A 62-year-old woman receiving methotrexate for Sezary syndrome was admitted for fever of 38.5̊C and overall impairment of her health. She presented a fistulous nodule on her right knee, and skin biopsy revealed a focus of ulcerated suppuration with quantities of Gram+ and Grocott+ granules containing no filament, enclosed by eosinophilic matter (Splendore-Hoeppli phenomenon). A sample of effusion from the sole of her right foot revealed a methicillin-sensitive strain of Staphylococcus aureus, which was also found in several blood cultures. Two abscessed nodules on the middle right lobe were visible on a thoracic CT scan despite the initial absence of respiratory symptoms. In view of this bacteraemia of cutaneous origin with sepsis caused by methicillin-sensitive S. aureus complicated by pulmonary abscesses, dual antibiotic treatment against staphylococci (cloxacillin-gentamicin followed by rifampicin-ofloxacin) was given over a two-month period.
  
  
  CONCLUSIONS
  The histological picture of granular bacteriosis suggested the possibility of botryomycosis or mycetoma. Botryomycosis involves chronic, relapsing, weeping and ulcero-vegetating abscesses. Mycetoma consists of fistulous swellings that secrete a discharge composed of blood and serum and containing grains made up of filaments. Although the staphylococcal organism identified was evocative of botryomycosis, the clinical findings were not consistent with either of these entities, since they revealed an acute bacterial abscess. The most adequate term is thus the more generic name of septic cutaneous granular abscess.
authors.affiliation: Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Mermin
authors.affiliation: Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Védie
authors.affiliation: Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Jullie
authors.affiliation: Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Fauconneau
authors.affiliation: Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France; Inserm U1053, équipe 3 oncogenèse des lymphomes cutanés, université de Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Beylot-Barry
authors.affiliation: Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France; Inserm U1053, équipe 3 oncogenèse des lymphomes cutanés, université de Bordeaux, France. Electronic address: anne.pham-ledard@chu-bordeaux.fr.
authors.forename: A
authors.initials: A
authors.lastname: Pham-Ledard
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017577:Cutaneous Fistula / Q000209:etiology; D003881:Dermatomycoses / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008169:Lung Abscess / Q000209:etiology; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis; D018805:Sepsis / Q000382:microbiology / Q000473:pathology*; D012751:Sezary Syndrome / Q000150:complications / Q000188:drug therapy; D013194:Staining and Labeling; D013203:Staphylococcal Infections / Q000382:microbiology / Q000473:pathology*; D013207:Staphylococcal Skin Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
keywords: Botryomycose; Botryomycosis; Pustule; Pustulosis; Sepsis; Sezary syndrome; Syndrome de Sézary