PMC4763675_01
Left leg showing (a) multiple nodules and discharging sinuses over medial aspect of thigh and groin (b) over calf (c) depressed scars over lower leg (d) scar on the sole, at the site of initial trauma
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F1
A few depressed scars were also found [Figure 1].
(a) Blood agar - Beta hemolysis (b) MacConkey agar - No growth (c) antibiotic sensitivity test plate - Methicillin sensitive Staphylococcus aureus (d) Gram-positive Cocci in minced tissue
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F2
Microscopy of minced tissue after Gram-stain showed Gram-positive cocci in groups and beta hemolysis was noted over blood agar, indicating Staphylococcus aureus as the underlying pathogen [Figure 2].
Histopathology (Grams-stain, x100). (a) Granule showing Gram-positive cocci surrounded by eosinophilic material (the Splendore-Hoeppli phenomenon)
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F3
Histopathological examination after Gram-stain revealed Gram-positive cocci surrounded by eosinophilic material (the Splendore-Hoeppli phenomenon) and further confirming the diagnosis to be botryomycosis [Figure 3].
After 2 months therapy, lesions healed with scarring over (a) thigh and groin (b) calf
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F4
Lesions healed with scarring after 2 months of therapy with cotrimoxazole [Figure 4].