DOI: 10.36347/sjmcr.2018.v06i12.015

Pages: 1054-1057

Botryomycosis is a chronic granulomatous bacterial infectious suppurated pathology. It is rare and can be localized on the skin and the viscera. The predisposing factor is most often a trauma. This case is about a 28 year-old patient with no particular pathological history, who was bitten by a donkey at the age of 7, on the anterior side of the right leg. For the last 10 years, she had a right lower limb swelling, made of an atypical prurigo nodular-like, suppurative lesion with fistulas. There is also a functional impotence of the limb. The mycological samples returned sterile. Bacteriological analysis of cutaneous biopsies showed Staphylococcus aureus. Histological examination revealed granulomatous grain abscess infection, suggestive of more bacterial grains, in favor of a botryomycosis. The patient was treated with bi-antibiotic therapy adapted to the sensitivity of S. aureus, including ciprofloxacin and sulfamethoxazole / trimethoprim. We also added weekly applications of trichloroacetic acid at 50% at the vegetative fistula lesions, with good results after 4 months of treatment. Cutaneous botryomocosis is a rare and underrated unit. Our case is particular because the donkey bite has not yet been described as being responsible for botryomycosis. Trauma such as a snake bite, intravenous long-term infusion, and a fork injury were reported. Making diagnosis may be difficult as it requires clinical, biological and especially histological features. Differential diagnosis must be eliminated, especially fungal mycetoma and actinomycosis. Staphylococcus aureus is the most incriminated, but there are often several germs at the same time (aerobic / anaerobic) which makes it difficult to sterilize the lesions. Histopathologic findings, like an inflammatory infiltrate made of granuloma with basophilic center of granular mass and eosinophilic periphery (called: Splendore-Hoeppli phenomenon, non-pathognomonic), with a clinical history may help for the diagnosis. Finally, ant