Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA.
Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
Skeletal Radiol. 2024 Oct;53(10):2315-2320. doi: 10.1007/s00256-023-04527-w. Epub 2023 Dec 1.
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.
细菌性真菌病是一种罕见的肉芽肿性反应，由慢性细菌感染引起，最常与金黄色葡萄球菌有关。这种疾病主要影响免疫功能低下的患者，可能表现为皮肤、内脏或软组织表现。软组织受累在影像学上通常表现为侵袭性块状外观，这可能令人担忧为恶性肿瘤。在免疫功能低下的患者中，细菌性真菌病在临床上和组织学上可能类似于真菌感染；因此，明确的诊断需要组织取样以及组织学和微生物学分析。这里介绍的是一名 25 岁男性，他的右前臂肌肉内软组织肿块增大，这是他未确诊的获得性免疫缺陷综合征 (AIDS) 的首次表现。磁共振成像显示轻度 T2 高信号和增强肿块，浸润性边缘穿过组织平面。肿块活检显示金黄色葡萄球菌相关的细菌性真菌病，经非手术治疗采用抗生素治疗后得到改善。不幸的是，患者随后因新诊断的 AIDS 的其他表现而死亡。本病例描述了细菌性真菌病的磁共振和 PET-CT 表现，并强调感染可模拟肉瘤，尤其是在免疫缺陷的情况下。
