CTICasesPulmonary and Visceral Botryomycosis (Staphylococcus aureus)
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Imaging findings
Chest radiograph showed bilateral mass-like lesions in the mid-lung zones, some well-defined. CT revealed striking findings of bilateral, extensive confluent areas of necrosis within the lungs, appearing as low-density mass-like lesions, worse at the lung bases, with cavitation in the left lower lobe. Post-contrast images confirmed the necrotic nature. Involvement of the kidney and liver with low-density lesions was also seen.
Key takeaways
Botryomycosis is a chronic suppurative infection characterized by a granulomatous inflammatory response to bacterial pathogens, most often Staphylococcus aureus. It can mimic actinomycosis on histopathology due to the presence of granules (Splendore-Hoeppli phenomenon), but lacks filamentous organisms. Visceral involvement (lungs, kidney, liver) is unusual but can occur. While associated with immunosuppression, it can also affect immunocompetent individuals. It is treated with antibiotics and can resolve significantly.
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