A CHALLENGING PRESENTATION OF BOTRYOMYCOSIS.

Botryomycosis is an exceptionally rare, chronic, suppurative bacterial infection that closely mimics fungal diseases both clinically and histopathologically. Despite its bacterial origin, the nomenclature suggests a mycotic etiology, often leading to diagnostic confusion and delayed treatment. The present case report documents a rare instance of cutaneous botryomycosis occurring in an immunocompetent middle-aged individual, presenting with chronic ulcerative and nodular lesions resistant to conventional antibiotic therapy. The study was conducted at Rama Medical College, Hapur, with systematic evaluation through clinical, histopathological, and microbiological methods. The patient reported a history of localized trauma at the affected site but had no signicant systemic illness or immunosuppressive condition. Clinical examination revealed multiple indurated nodules and ulcerated plaques with sinus tract formation, seropurulent discharge, and surrounding hyperpigmentationfeatures that initially resembled chronic fungal or mycetomal infections. To conrm diagnosis, a comprehensive investigative approach was adopted, including hematological and biochemical testing, imaging to rule out systemic spread, and histopathological examination of biopsy specimens. The biopsy demonstrated a dense granulomatous inammatory reaction with the characteristic Splendore–Hoeppli phenomenon-an eosinophilic sheath surrounding bacterial colonies. Microbiological culture of pus samples on blood agar conrmed Staphylococcus aureus as the causative agent, consistent with the most frequently reported pathogen in botryomycosis.Therapeutically, the case was managed through prolonged, culture-directed antibiotic therapy with oral cloxacillin, supported by wound care, topical antimicrobials, and surgical debridement of necrotic tissue. This integrated medical-surgical approach produced remarkable improvement, with signicant regression of nodular and ulcerative lesions and resolution of discharge within eight weeks. The patient was followed up for recurrence and continued to show stable healing and restored skin integrity. The multidisciplinary strategy—combining dermatological evaluation, microbiological culture, and histopathological validation—proved essential for diagnostic conrmation and successful outcome. The report further underscores the importance of correlating clinical ndings with histopathological and microbiological evidence, particularly in rare infectious diseases that present with overlapping features.From an analytical standpoint, this case highlights several key clinical implications. First, botryomycosis should be considered a potential differential diagnosis in cases of chronic, non-healing granulomatous infections, especially when standard treatments fail. Second, the condition may occur even in immunocompetent individuals, emphasizing that trauma and localized skin injury alone can serve as important predisposing factors. Third, the study exemplies how misdiagnosis as mycetoma, actinomycosis, or deep fungal infection can lead to inappropriate therapy and prolonged morbidity. Finally, this case reafrms that early recognition and culture-based management are pivotal for favorable outcomes. Overall, the case enriches existing medical literature by adding evidence from the Indian subcontinent-where reports of human botryomycosis remain scarce-and serves as a valuable reminder to clinicians and microbiologists to maintain high diagnostic vigilance. By documenting detailed clinical, histopathological, and microbiological ndings, this paper contributes to the limited repository of knowledge surrounding botryomycosis and reinforces the need for a multidisciplinary diagnostic approach in rare bacterial infections mimicking mycoses.