Case Number : CT0004 Dr. Hafeez Diwan

Guest Engin Sezer - Histoplasmosis vs. botyromycosis
 
Arti Bakshi - Blue staining granules (?bacteria) with surrounding Splendore- Hoeppli phenomenon
?Botyromycosis ??Actinomycosis
 
Robledo F. Rocha - I go with botryomycosis unless special stains prove otherwise. Grains appear as basophilic granules rather than filamentous.
 
Dr. Richard Carr - Botryomycosis was my first consideration, most likely some Staphylococcus?
 
Dr. Mona Abdel-Halim - Botryomycosis is my first impression also,,, lovely :-)
  
Guest Jim Davie MD - Favor Staphylococcal botyromycosis (agree with Richard). The bacteria are forming closely packed, but distinct tetrads (squares of 4 cocci) plus clusters, which is common in Staphylococcus (doubt Micrococcus). I don't see filamentous bacteria suggestive of a coexistent Actinomycete. Differential Dx would include incidental cocciform impetiginization, as a distraction in a lesion caused by something else not easily seen in these photos (foreign body, fungus, etc). Staining for fungus would be prudent.
 
Dr. Hafeez Diwan - I called this botryomycosis.