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with hematic crust on the surface and some areas of bleeding&#44; measuring 5&#215;5 centimeters &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy was taken for the clinical hypothesis of squamous cell carcinoma vs&#46; amelanotic melanoma&#59; the result of the histopathological study showed pseudoepitheliomatous hyperplasia with basophilic granular bodies &#40;grains&#41; with numerous neutrophils &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; Microbiological cultures were negative&#46; The diagnosis of the exophytic botryomycosis was made&#44; surgical resection was indicated by the plastic surgery service&#44; and antibiotic management with trimethoprim-sulfamethoxazole was started&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Botryomycosis derives from the Greek &#8220;botrys&#8221; &#40;bunch of grapes&#41; and &#8220;myces&#8221; &#40;fungus&#41; because initially&#44; a fungal etiology was suspected&#46; Two types of the presentation can be described&#44; cutaneous and visceral&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The cutaneous presentation represents 75&#37; of the reported cases&#44; the remaining 25&#37; correspond to the visceral type&#46; Botryomycosis can occur at any age&#44; although it rarely occurs in &#8216;children&#8217;s and adults over 70-years old&#44; it mainly involves areas with greater susceptibility to trauma such as hands&#44; feet&#44; head and neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The history of trauma is the most important risk factor&#44; in the case presented in this article&#44; this was the probable method of inoculation since the patient works in agriculture&#46; Other risk factors linked are immunosuppression&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; liver disease&#44; alcoholism&#44; systemic lupus&#44; cystic fibrosis&#44; malnutrition&#44; immunoglobulin deficiency&#44; glomerulonephritis&#44; HIV&#47;AIDS&#44; or surgery history&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathogenesis of this entity is not well understood&#44; and many authors agree that this reaction corresponds to a Splendore-Hoeppli phenomenon&#44; in which antigen-antibody complex&#44; immunoglobulin G and C3 are precipitated&#44; a process in which phagocytosis and intracellular bacterial destruction is prevented&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The &#39;patient&#8217;s present nodules&#44; fistulas&#44; abscesses&#44; and ulcers with seropurulent exudate in which 3&#8210;5&#8239;mm white-yellowish granules can be seen and the systemic infection has not been observed&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The diagnosis is made by isolating the causative agent&#59; however&#44; it is not easy to isolate&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis is other infectious granulomatous diseases such as mycetoma&#44; actinomycosis&#44; sporotrichosis&#44; cutaneous tuberculosis&#44; and malignant tumor diseases such as squamous cell carcinoma and amelanotic melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Antibiotic treatment should be directed to the causative agent&#44; in the case of extensive lesions&#44; failure of systemic treatment&#44; or severely immunocompromised patients&#44; excision and drainage of the lesions are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> In our case&#44; the treatment was tumor excision by the plastic surgery service with reconstruction with partial-thickness graft&#44; additionally&#44; empirical treatment with trimethoprim-sulfamethoxazole was given due to the epidemiological profile and possible causative agent&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We present the clinical case of exophytic botryomycosis&#44; an unusual clinical presentation previously not reported in the literature&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Lina Paola Gonz&#225;lez-Cardona&#58; Critical literature review&#59; critical manuscript review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Adriana Mercedes Alejo Villamil&#58; Data collection&#44; analysis and interpretation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Carolina Cort&#233;s Correa&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Elkin Omar Pe&#241;aranda Contreras&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Exophytic botryomycosis: An unusual clinical presentation
Lina Paola González-Cardonaa,
Corresponding author
linapgonzalezc@gmail.com

Corresponding author.
, Adriana Mercedes Alejo Villamila, Carolina Cortés Correab, Elkin Omar Peñaranda Contrerasb
a Pontificia Universidad Javeriana, Bogotá, Colombia
b Hospital Universitario de la Samaritana, Bogotá, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Botryomycosis is a chronic infectious disease of bacterial origin&#44; granulomatous and suppurative with a worldwide distribution&#46; The incidence and prevalence are unknown&#44; although it is considered an infrequent entity&#44; with approximately 200 cases reported around the world&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 42-year-old male patient&#44; a farmer&#44; arrives at the dermatology service with a slow-growing lesion that had appeared 2-years earlier in the great toe finger of the right foot&#46; The patient reported pain of moderate intensity that was enhanced with daily walking&#44; as well as self-limited bleeding&#46; Physical exam reveals in the dorsal aspect of the great toe finger an exophytic ulcerated tumor&#44; erythematous&#44; with hematic crust on the surface and some areas of bleeding&#44; measuring 5&#215;5 centimeters &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy was taken for the clinical hypothesis of squamous cell carcinoma vs&#46; amelanotic melanoma&#59; the result of the histopathological study showed pseudoepitheliomatous hyperplasia with basophilic granular bodies &#40;grains&#41; with numerous neutrophils &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; Microbiological cultures were negative&#46; The diagnosis of the exophytic botryomycosis was made&#44; surgical resection was indicated by the plastic surgery service&#44; and antibiotic management with trimethoprim-sulfamethoxazole was started&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Botryomycosis derives from the Greek &#8220;botrys&#8221; &#40;bunch of grapes&#41; and &#8220;myces&#8221; &#40;fungus&#41; because initially&#44; a fungal etiology was suspected&#46; Two types of the presentation can be described&#44; cutaneous and visceral&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The cutaneous presentation represents 75&#37; of the reported cases&#44; the remaining 25&#37; correspond to the visceral type&#46; Botryomycosis can occur at any age&#44; although it rarely occurs in &#8216;children&#8217;s and adults over 70-years old&#44; it mainly involves areas with greater susceptibility to trauma such as hands&#44; feet&#44; head and neck&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The history of trauma is the most important risk factor&#44; in the case presented in this article&#44; this was the probable method of inoculation since the patient works in agriculture&#46; Other risk factors linked are immunosuppression&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; liver disease&#44; alcoholism&#44; systemic lupus&#44; cystic fibrosis&#44; malnutrition&#44; immunoglobulin deficiency&#44; glomerulonephritis&#44; HIV&#47;AIDS&#44; or surgery history&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathogenesis of this entity is not well understood&#44; and many authors agree that this reaction corresponds to a Splendore-Hoeppli phenomenon&#44; in which antigen-antibody complex&#44; immunoglobulin G and C3 are precipitated&#44; a process in which phagocytosis and intracellular bacterial destruction is prevented&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The &#39;patient&#8217;s present nodules&#44; fistulas&#44; abscesses&#44; and ulcers with seropurulent exudate in which 3&#8210;5&#8239;mm white-yellowish granules can be seen and the systemic infection has not been observed&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The diagnosis is made by isolating the causative agent&#59; however&#44; it is not easy to isolate&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis is other infectious granulomatous diseases such as mycetoma&#44; actinomycosis&#44; sporotrichosis&#44; cutaneous tuberculosis&#44; and malignant tumor diseases such as squamous cell carcinoma and amelanotic melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Antibiotic treatment should be directed to the causative agent&#44; in the case of extensive lesions&#44; failure of systemic treatment&#44; or severely immunocompromised patients&#44; excision and drainage of the lesions are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> In our case&#44; the treatment was tumor excision by the plastic surgery service with reconstruction with partial-thickness graft&#44; additionally&#44; empirical treatment with trimethoprim-sulfamethoxazole was given due to the epidemiological profile and possible causative agent&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We present the clinical case of exophytic botryomycosis&#44; an unusual clinical presentation previously not reported in the literature&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Lina Paola Gonz&#225;lez-Cardona&#58; Critical literature review&#59; critical manuscript review&#59; preparation and writing of the manuscript&#59; study conception and planning&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Adriana Mercedes Alejo Villamil&#58; Data collection&#44; analysis and interpretation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Carolina Cort&#233;s Correa&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Elkin Omar Pe&#241;aranda Contreras&#58; Approval of the final version of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic&#59; management of studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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