A Case of mistreated Botryomycosis as Nocardiosis, in a patient with MDR-TB

Abstract

Introduction: Botryomycosis is a chronic purulent, granule-producing granulomatous infection affecting the skin, subcutaneous tissue, and visceral organs, primarily caused by Staphylococcus aureus and other bacterial species. It is commonly seen in individuals with impaired cell-mediated immunity and mimics mycetoma and actinomycosis, necessitating accurate diagnosis for effective treatment. Case History: A 26-year-old male presented with a gradually enlarging left cheek swelling following facial trauma six months prior. The swelling was associated with pus discharge and nodular formation, who was misdiagnosed and being treated as nocardiosis. The patient had a history of multidrug-resistant tuberculosis (MDR-TB) and alcohol dependence. Material & Methods: Pus samples were sent for microbiological examination, including Gram’s stain, ZN stain, and culture on Blood agar, MacConkey agar, and SDA slope, and also for molecular studies. Growth was observed, and preliminary biochemical reactions were performed. Results: Gram-positive cocci in clusters were identified, with positive catalase and slide coagulase tests. Biochemical and antimicrobial susceptibility testing confirmed Methicillin-resistant Staphylococcus aureus (MRSA). Histopathological staining supported the diagnosis. Conclusion: Accurate diagnosis of botryomycosis is essential for targeted antibiotic therapy. Long-term treatment is required based on bacterial susceptibility patterns, ensuring effective management.

Keywords: Botryomycosis, Methicillin resistant staphylococcus aureus, Splendore-Hoeppli reaction, granulation