Publication date: Available online 26 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Mermin, A.-L. Védie, M.-L. Jullie, A. Fauconneau, M. Beylot-Barry, A. Pham-Ledard
IntroductionNous rapportons une observation de bactériose cutanée à grains, permettant de discuter du cadre nosologique de cette entité à partir d'une approche clinique et histologique.ObservationUne femme de 62 ans, traitée par méthotrexate pour un syndrome de Sézary, était admise pour fièvre à 38,5̊C et altération de l'état général. Elle présentait un nodule fistulisé du genou droit dont la biopsie cutanée révélait un foyer de suppuration ulcéré avec amas de grains Gram+ et Grocott+ sans filament, entourés de matériel éosinophile (phénomène de Splendore-Hoeppli). Le prélèvement d'un écoulement plantaire droit identifiait une souche de Staphylococcus aureus sensible à la méthicilline, trouvée également dans plusieurs hémocultures. Deux nodules abcédés du lobe moyen droit étaient visibles sur la tomodensitométrie thoracique, contrastant avec l'absence initiale de symptômes respiratoires. Devant cette bactériémie d'origine cutanée avec sepsis à S. aureus méthi-sensible compliqué d'abcès pulmonaires, une bi-antibiothérapie anti-staphylococcique (cloxacilline-gentamicine relayés par rifampicine-ofloxacine) était maintenue pendant deux mois.DiscussionL'image histologique de bactériose à grains fait discuter une botryomycose ou un mycétome. Les botryomycoses correspondent à des abcès suppuratifs chroniques, ulcéro-végétants, récidivants. Les mycétomes sont des tuméfactions fistulisées libérant un matériel séro-sanglant granuleux constitué de filaments. Bien que le staphylocoque identifié orientait vers une botryomycose, la clinique n'était typique d'aucune de ces entités car il s'agissait d'un abcès bactérien aigu. Le terme le plus adéquat est donc celui, plus générique, d'abcès cutané septique à grains.BackgroundHerein we report a case of cutaneous granular bacteriosis, with discussion of the nosological setting of this entity based upon the clinical and histological findings.Patients and methodsA 62-year-old woman receiving methotrexate for Sezary syndrome was admitted for fever of 38.5̊C and overall impairment of her health. She presented a fistulous nodule on her right knee, and skin biopsy revealed a focus of ulcerated suppuration with quantities of Gram+ and Grocott+ granules containing no filament, enclosed by eosinophilic matter (Splendore-Hoeppli phenomenon). A sample of effusion from the sole of her right foot revealed a methicillin-sensitive strain of Staphylococcus aureus, which was also found in several blood cultures. Two abscessed nodules on the middle right lobe were visible on a thoracic CT scan despite the initial absence of respiratory symptoms. In view of this bacteraemia of cutaneous origin with sepsis caused by methicillin-sensitive S. aureus complicated by pulmonary abscesses, dual antibiotic treatment against staphylococci (cloxacillin-gentamicin followed by rifampicin-ofloxacin) was given over a two-month period.DiscussionThe histological picture of granular bacteriosis suggested the possibility of botryomycosis or mycetoma. Botryomycosis involves chronic, relapsing, weeping and ulcero-vegetating abscesses. Mycetoma consists of fistulous swellings that secrete a discharge composed of blood and serum and containing grains made up of filaments. Although the staphylococcal organism identified was evocative of botryomycosis, the clinical findings were not consistent with either of these entities, since they revealed an acute bacterial abscess. The most adequate term is thus the more generic name of septic cutaneous granular abscess.
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