FATAL MURAL ENDOCARDITIS AND CUTANEOUS BOTRYOMYCOSIS AFTER HEART-TRANSPLANTATION

Fatal mural endocarditis and botryomycosis occurred concurrently in a 62-year-old women 4 months after orthotopic heart transplantation. Sub sequent to mild mitral regurgitation, infection developed on a left at rial thrombus and was complicated by cerebral embolization. Simultaneo usly, skin nodules manifested on both forearms. Histologic examination revealed typical aspects of early evolving botryomycosis with massive infiltration of the dermis and hypodermis by necrotic granulomas fram ed by grains of Gram-positive coccoid forms. Bacteria were decorated b y a nonspecific polyclonal antibody to Mycobacterium bovis.