BOTRYOMYCOSIS CAUSED BY PSEUDOMONAS-VESICULARIS

A 60-year-old man had a granulomalous verrucous plaque over the back o f his right hand, of 1-year duration that had begun after trauma with an electric drill. On examination, the patient had a 4 x 7 cm plaque, composed of multiple red nodules, with micro-pustules and crusting on the surface (Fig. 1). The patient had been previously treated for spor otrichosis with terbinafine, itraconazole, and local hyperthermia with no response. Previous cultures from purulent drainage material grew S taphylococcus aureus. Antibiotics had been given according to sensitiv ity tests but without a clinical response. Chemical and hematologic va lues were within normal limits. A roentgenogram of the area showed onl y soft tissue changes. On compression of areas of purulent drainage, g ranules were expelled. Their direct examination revealed soft, lobulat ed granules, with peripheral clubs up to 300 mu m in diameter. The gra nules were composed of masses of short gram-negative coccobacilli. Cul ture of the granules gave slowly growing colonies of Pseudomonas vesic ularis. The patient was then treated with a 4-month course of cefuroxi me axetil, 250 mg t.i.d., with obvious improvement (Fig. 2).