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Botryomycosis pathology

Author: Assoc Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.

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Botryomycosis pathology — codes and concepts


Botryomycosis (bacterial pseudomycosis) is an uncommon chronic bacterial infection of skin caused by masses of colonizing bacteria. Staphylococcus aureus is the usual cause, but a wide range of gram negative organisms have also been isolated.

Histology of botryomycosis

Histopathologic examination of botryomycosis shows a marked inflammatory response, scarring and suppuration. Trans-epidermal elimination, and marked epithelial hyperplasia may also sometimes be seen (figure 1).

Botryomycosis resembles mycetoma with granules present within suppurative inflammation. The granules are composed of blue-stained bacteria surrounded by an intensely eosinophilic coat (the Splendore-Hoeppli Phenomenon, figure 2).

Botryomycosis pathology

Special stains for botryomycosis

Gram stain will detect bacterial forms of botryomcyosis. PAS stain stains the granule.

Differential diagnosis of botryomycosis pathology

Mycetoma – In contrast to mycetoma, botryomycosis is not caused by fungi or actinomycosis.

Disseminated infections – A disseminated infection will have a diffuse pattern of invasion without localized granules.

Squamous cell carcinoma – A massive epidermal reaction (figure 1) can be confused with an invasive carcinoma, particularly if only the surface of a lesion is biopsied.



  • DERM101.COM Ackerman, A. Bernard (2000)
  • Pathology of the Skin (Fourth edition, 2012). McKee PH, J. Calonje JE, Granter SR

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