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Botryomycosis: a rare mimic of sarcoma as an initial presentation of acquired immunodeficiency syndrome

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Abstract

Botryomycosis is a rare granulomatous response to chronic bacterial infection most frequently associated with Staphylococcus aureus. This disease, which predominantly affects immunocompromised patients, may present with cutaneous, visceral, or soft tissue manifestations. Soft tissue involvement typically has an aggressive mass-like appearance on imaging which can be concerning for malignancy. In immunocompromised patients, botryomycosis can resemble fungal infection both clinically and histologically; therefore, definitive diagnosis requires tissue sampling along with histological and microbiological analysis. Presented here is a 25-year-old man with an enlarging intramuscular soft tissue mass of the right forearm as his first presentation of undiagnosed acquired immunodeficiency syndrome (AIDS). MR imaging showed a mildly T2 hyperintense and enhancing mass with infiltrative margins extending through tissue planes. Biopsy of the mass revealed Staphylococcus aureus–associated botryomycosis, which improved with nonsurgical treatment employing antibiotics. Unfortunately, the patient subsequently expired from other manifestations of his new AIDS diagnosis. This case describes the MR and PET-CT appearance of botryomycosis and also underscores that infection can mimic sarcoma, particularly in the setting of immunodeficiency.

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Authors and Affiliations

  1. Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA

    Sean L. Boone

  2. Department of Pathology, University of California San Francisco, San Francisco, CA, USA

    Andrew E. Horvai

  3. Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA

    Melissa N. Zimel

  4. Morehouse School of Medicine, Atlanta, GA, USA

    Robert Brown

  5. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Thomas M. Link & Kevin C. McGill

Authors
  1. Sean L. Boone
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  2. Andrew E. Horvai
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  3. Melissa N. Zimel
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  4. Robert Brown
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  5. Thomas M. Link
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  6. Kevin C. McGill
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Correspondence to Sean L. Boone.

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Boone, S.L., Horvai, A.E., Zimel, M.N. et al. Botryomycosis: a rare mimic of sarcoma as an initial presentation of acquired immunodeficiency syndrome. Skeletal Radiol (2023). https://doi.org/10.1007/s00256-023-04527-w

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  • DOI: https://doi.org/10.1007/s00256-023-04527-w

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