Case Report

Small Vessel Vasculitis in a Patient with Botryomycosis

MONICA J. SNOWDEN, TIMOTHY E. McALINDON, CRISTIAN G. MOROSAN, and GRACE H. LO

ABSTRACT.

We describe a 53 year-old woman with primary biliary cirrhosis presenting with left ankle swelling and a purpuric rash. The skin biopsy of the rash revealed a small vessel vasculitis and a botryomycosis with Splendore-Hoeppli phenomenon. Botryomycosis is an uncommon histologic finding of a chronic suppurative bacterial infection whereby bacteria form aggregates, which are surrounded by an eosinophilic matrix. With guidance from the skin biopsy findings, the patient was appropriately treated with antibiotics, resulting in complete resolution of symptoms. (J Rheumatol 2006;33:2545–7)

Key Indexing Terms:

VASCULITIS
BOTRYOMYCOSIS

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From the Division of Rheumatology, Department of Medicine, and the Department of Pathology and Laboratory Medicine, Tufts University, Boston, Massachusetts, USA.

M.J. Snowden, MD, Rheumatology Fellow; T.E. McAlindon, MD, MPH, Chief of Rheumatology; C.G. Morosan, MD, Resident in Pathology; G.H. Lo, MD, MSc, Assistant Professor of Medicine.

Address reprint requests to Dr. G.H. Lo, #406 750 Washington St., Tufts-New England Medical Center, Boston, MA 02111. E-mail: glo@tufts-nemc.org

Accepted for publication July 24, 2006.

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