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Abstract

Botryomycosis is a rare, chronic bacterial infection most commonly caused by Staphylococcus aureus. Although the skin is the most common site of infection, other visceral organs, especially the lungs, can be affected. The misnomer mycosis alludes to its clinical and histological resemblance to a fungal infection. We present two cases of botryomycosis occurring in an unusual location: an 85-year-old male with a one-year history of draining nodules in the right axilla and a 92-year-old male with a 3-week history of a solitary draining nodule in the right axilla. Neither patient had systemic symptoms, was immunocompromised, nor had tried previous treatments. Shave biopsies in both cases demonstrated dermal granules of cocci bacteria with an eosinophilic rim representing the Splendore-Hoeppli phenomenon. Tissue cultures were obtained from one patient which grew methicillin-resistant Staphylococcus aureus. Both patients were placed on 30-day courses of 100 mg doxycycline twice daily with clinical resolution. Although botryomycosis classically involves the foot, the diagnosis should be considered for chronic draining nodules in unusual locations.