Cervicofacial Botryomycosis: Is Atopic Dermatitis a Predisposing Factor?

BACKGROUND Botryomycosis is a rare infectious disease which usually affects the skin. The low virulence of the bacteria tending to form grains and the immune status of the host are important factors in the development of the disease. METHODS We report a case of cervicofacial botryomycosis and review the current literature. RESULTS A 47-year-old male with a long history of moderate-to-severe atopic dermatitis presented with painful and suppurative nodules of the head and neck. A skin biopsy revealed granules consisting of Gram-positive bacterial colonies in a blossom-like assembly in the center and an eosinophilic rim in the periphery, which are pathognomonic features of botryomycosis. The lesions responded well to systemic antibiotics; however, they rapidly relapsed upon cessation of the treatment. CONCLUSIONS We highlight the well-defined histologic features and recall an almost forgotten disease. We review common predisposing conditions and present evidence that atopic dermatitis might be an additional predisposing factor.