Botryomycosis

Botryomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. Main etiological agent is Staphylococcus aureus and less commonly Pseudomonas spp., Escherichia coli, Proteus spp., Streptococcus spp. We here report a case of 32-year-old male with polymicrobial botryomycosis on forehead and on frontal scalp. Culture from lesions revealed growth of S. aureus initially. Partial resolution was achieved with cefadroxyl and clavulanic acid, rifampicin, and linezolid. Subsequent repeat culture revealed E. coli sensitive to netilmycin. Slow and steady resolution was achieved with surgical debridement and combination therapy of injectable netilmycin and oral sufomethoxazole and trimethoprim for a prolonged period.