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Key Clinical Message: This case report explores the clinical journey of a patient initially diagnosed with botryomycosis, only to later reveal the underlying and rare condition of actinomycosis. The report highlights the challenges in getting to an accurate diagnosis, emphasizing the importance of considering uncommon pathologies, the utility of multi‐disciplinary teams and clinico‐pathologic correlation in clinical practice. [ABSTRACT FROM AUTHOR]

Botryomycosis is a rare chronic granulomatous bacterial infection with approx. 200 reported cases worldwide. The most common microorganism associated with this condition is Staphylococcus aureus. Botryomycosis manifests itself across a spectrum of lesions with a characteristic histological feature known as the Splendore–Hoeppli phenomenon. Herein, we report the case of a 35-year-old female presenting with an ulcerated lesion and a previous diagnosis of lymphoblastic leukemia. Botryomycosis should be considered in immunosuppressed patients with ulcerated lesions. Treatment duration may range from four to eight weeks, with debridement if necessary. It is essential to exclude visceral involvement. [ABSTRACT FROM AUTHOR]

Key Clinical Message This case report explores the clinical journey of a patient initially diagnosed with botryomycosis, only to later reveal the underlying and rare condition of actinomycosis. The report highlights the challenges in getting to an accurate diagnosis, emphasizing the importance of considering uncommon pathologies, the utility of multi‐disciplinary teams and clinico‐pathologic correlation in clinical practice.

Summary: Botryomycosis is an uncommon chronic bacterial pyogranulomatous infection of cutaneous and, rarely of visceral origin, that can rarely invade the osseous tissues. An 8‐year‐old Friesian gelding was presented with severe bilateral hindlimb ataxia and paresis of 2‐weeks' duration. Radiographic examination revealed a large osteolytic lesion at the T10‐T11 intervertebral disc space. Post‐mortem examination revealed discospondylitis with abscess formation and histological presence of pyogranulomatous inflammation with coccoform bacteria rimmed by Splendore‐Hoeppli material. Staphylococcus aureus was identified by bacteriological examination. This case report describes the clinical presentation, imaging features and post‐mortem findings of a Friesian gelding presenting with severe bilateral hindlimb ataxia and paresis caused by compression and degeneration of the spinal cord due to a botryomycosis‐like thoracic discospondylitis. Botryomycosis‐like infection should be considered in the differential diagnosis of focal expansile bone lesions demonstrating diffuse osteolysis, sclerosis and interrupted bone margins. [ABSTRACT FROM AUTHOR]

Objectives: Botryomycosis is a rare chronic granulomatous inflammatory disease of bacterial origin. Two forms of the disease exist; the cutaneous and the visceral form. The subcutaneous form mimics actinomycetoma clinically and histologically; however, the treatment is different. In this communication, we report on a Sudanese male patient who presented with foot botryomycosis. Design: Case report. Results: The patient was initially diagnosed with actinomycetoma by the presence of Streptomyces somaliensis like-grains in the histological slides. The patient was treated with a combination of co-trimoxazole and amikacin sulfate and shifted after 1 year to co-trimoxazole, amoxicillin, and clavulanic acid. Despite treatment, the infection progressed, and the bone was invaded. The infected limb was amputated. The histopathological report of the surgical biopsy showed gram-positive cocci inside the grain. The 16S sequence identified these cocci as Staphylococcus aureus. Conclusion: This is the first reported botryomycosis case from Sudan, and it highlights why molecular identification is vital in diagnosis.

Botryomycosis is a rare pyogenic disease that presents with chronic suppurative and granulomatous skin lesions, commonly caused by Staphylococcus aureus . We report a case of botryomycosis presenting similarly to mycetoma, secondary to the emerging cutaneous pathogen Staphylococcus simulans. A 46-year-old female who previously worked in a wet market presented with a 13-year history of suppurative papules on a gradually enlarging right foot, and pain on ambulation. She had no systemic symptoms or co-morbidities, and does not recall preceding trauma. Physical examination showed brawny edema of the right foot with multiple sinus tracts draining purulent discharge. The clinical diagnosis at presentation was mycetoma. Magnetic resonance imaging showed a soft tissue mass involving the right foot and ankle with osseous destruction. Biopsy revealed suppurative granulomatous dermatitis; staining with Grocott methenamine silver did not highlight fungal elements. Potassium hydroxide mount of the purulent discharge did not show grains or hyphal elements. Tissue cultures showed growth of co-trimoxazole-susceptible Staphylococcus simulans . The patient was managed as a case of botryomycosis and treated with co-trimoxazole for 12 months. There was a significant decrease in right foot circumference along with scarring and resolution of associated pain. Repeat biopsy showed no evidence of infection. This is the first reported case of botryomycosis in the Philippines as well as the first report citing Staphyloccocus simulans as a causative agent. Botryomycosis is an important differential in patients clinically presenting as mycetoma. Animal pathogens may need to be considered as etiologic agents in at-risk patients with chronic subcutaneous infections., Competing Interests: Both authors declared no conflicts of interest., (© 2024 Acta Medica Philippina.)

• Botryomycosis is a chronic granulomatous disease often caused by Staphylococcus aureus. • Botryomycosis mimics actinomycetoma clinically and radiologically. • Molecular identification can differentiate the two. • Gram stain can be used to differentiate botryomycosis and actinomycetoma grains. Botryomycosis is a rare chronic granulomatous inflammatory disease of bacterial origin. Two forms of the disease exist; the cutaneous and the visceral form. The subcutaneous form mimics actinomycetoma clinically and histologically; however, the treatment is different. In this communication, we report on a Sudanese male patient who presented with foot botryomycosis. Case report. The patient was initially diagnosed with actinomycetoma by the presence of Streptomyces somaliensis like-grains in the histological slides. The patient was treated with a combination of co-trimoxazole and amikacin sulfate and shifted after 1 year to co-trimoxazole, amoxicillin, and clavulanic acid. Despite treatment, the infection progressed, and the bone was invaded. The infected limb was amputated. The histopathological report of the surgical biopsy showed gram-positive cocci inside the grain. The 16S sequence identified these cocci as Staphylococcus aureus. This is the first reported botryomycosis case from Sudan, and it highlights why molecular identification is vital in diagnosis. [ABSTRACT FROM AUTHOR]

Botryomycosis is a chronic bacterial infection of the skin and viscera caused by nonbranching bacteria such as Staphylococcus spp. It results in the formation of chronic, suppurative and often granulomatous lesions that may resemble multiple abscesses. It has been diagnosed worldwide in both humans and animals. It is a rare disease, usually requiring surgical excision combined with long‐term antibiotics to achieve a good resolution. A wild echidna (Tachyglossus aculeatus) was presented with a soft tissue mass at the base of the right distal beak with multiple discharging fistulas arising from it. The mandible appeared to be shortened and deviated to the right, and the animal was unable to close its beak. The echidna was in poor body condition and was euthanased on welfare grounds. Histopathology of the lesions demonstrated the classical botryoid lesions with the characteristic Splendore‐Hoeppli reaction surrounding the bacterial colonies, in a background of extensive granulation tissue. Radiographs revealed mild mandibular osteomyelitis, yet haematology and biochemistry results were nonspecific. This disease has not previously been reported in a wild monotreme. [ABSTRACT FROM AUTHOR]

Botryomycosis is a rare, chronic suppurative granulomatous bacterial infection of skin, soft tissue, and viscera with aggregates of nonbranching gram positive or negative bacteria. This is a very rare infection usually under diagnosed, mostly seen in immunocompromised state, so far only few case reports were reported worldwide. 59-year-old gentleman from Port Blair, with no comorbidities came with complaints of cough with expectoration for past six months who already received multiple treatments outside. On examination, he had basal crepitation’s in right infrascapular area. His chest X-ray showed right lower zone opacity. Blood investigation revealed leukocytosis with elevated ESR. HRCT Chest revealed right lower lobe consolidation. Bronchoscopy was done which showed mobile intrabronchial mass in RLL-CBS. Following removal, he improved. Histopathological examination of foreign body revealed vegetative material and showed gram negative bacteria with interspersed gram-positive bacteria surrounded by splendore-hoepplii phenomenon suggestive of botryomycosis. He was treated with antibiotics and he improved well.

Botryomycosis is a rare chronic granulomatous infection that usually involves the skin and rarely viscera. The main causative organism is Staphylococcus aureus, and rarely, Pseudomonas and Escherichia coli. Both cutaneous and visceral forms of the disease are recognized. Botryomycosis may develop in apparently healthy individuals as well as the immunologically compromised. The involvement of orofacial region is rare in the literature. Diagnosing botryomycosis is very challenging. Dental specialists require thorough knowledge regarding the features and management of this infrequent entity in their practice. Isolation of the causative agent and antibiotic susceptibility tests are essential to provide appropriate treatment. We hereby report a rare case of a 37-year-old healthy male with recurrent episodes of botryomycosis involving the orofacial region. The present report highlights the clinical and histopathologic features of botryomycosis with literature review.

Botryomycosis is a rare chronic suppurative granulomatous infection caused by several genera of non‐filamentous bacteria. The clinical and histopathological findings are similar to those of mycetoma caused by true fungi or aerobic actinomycetes. Botryomycosis is divided into cutaneous and visceral disease, with the cutaneous form being more common. Histopathology shows granules of etiologic bacteria called "sulfur granules". Botryomycosis occurs more commonly among immunocompromised patients, although some cases have also been reported in immunocompetent patients. We report the case of an 8‐year‐old immunocompetent boy who visited our hospital with a 4‐mm diameter subcutaneous tumor with mild tenderness on his right heel for several months. We surgically removed the tumor with an initial diagnosis of epidermal cyst. Histopathology showed sulfur granules surrounded by an eosinophilic matrix, indicating the Splendore–Hoeppli phenomenon. The granules consisted of Gram‐positive cocci, leading to a diagnosis of botryomycosis. The patient was successfully treated by excision and oral trimethoprim/sulfamethoxazole (240 mg b.i.d.) for 2 weeks as adjuvant therapy. No recurrence was noted following treatment. The subcutaneous tumor in this case was smaller than the typical in botryomycosis infections. We reviewed the infection duration and tumor size in reported cases of botryomycosis in immunocompetent patients. Small tumor size may suggest that the case is in an early stage; therefore, it is important to remove and investigate these lesions proactively. [ABSTRACT FROM AUTHOR]

Chronic pyo-granulomatous infection of subcutaneous tissues with recurrence and exacerbations are predominantly of bacterial origin in Southern India. Most of the infections may not present with the classic triad to be labeled as mycetoma. Frequently, granular discharge is absent or not elicited. More often the infection is monomicrobial. However, rare polymicrobial infections are posing challenges in the treatment of the same. The genus Alternaria belongs to phaeoid fungi infecting immunocompromised hosts. They are associated with cutaneous and subcutaneous infections (70-80%) predominantly. We recount a rare case of chronic subcutaneous mixed infection by Alternaria alternata and methicillin sensitive Staphylococcus aureus in a healthy, immunocompetent, non-diabetic woman.

Summary: Botryomycosis is an uncommon chronic bacterial infection that can have cutaneous and visceral involvement. This report describes an 18‐year‐old mixed‐breed mare presented with dysphagia, dyspnoea and an upper respiratory noise that developed secondary to oropharyngeal botryomycosis. Histological examination of the mass showed a granulomatous formation with Splendore–Hoeppli phenomenon surrounding Gram‐positive bacteria. This report describes the clinical signs, approach and management of an oropharyngeal Staphylococcus aureus granuloma in a geriatric mare. [ABSTRACT FROM AUTHOR]

Abstract A 5-year-old male neutered rabbit was presented for assessment of multiple abscesses, which had appeared suddenly over the ventrum, perineum, and hindlimbs over the past few days. Thirteen abscesses were surgically excised. Culture revealed Pseudomonas aeruginosa and histopathological examination confirmed a diagnosis of botryomycosis. However, despite follow-up antimicrobial treatment and repeat surgeries, lesions continued to recur. The second case, a 3-year-old male neutered rabbit presented for routine vaccination. On physical examination, multiple small nodules were palpated over the right shoulder region. Surgical excision was performed and histopathology again yielded a diagnosis of botryomycosis. So far, no recurrence has been seen in this case. Botryomycosis is a rare chronic pyogranulomatous infection and naturally occurring disease has not been previously reported in pet rabbits. These cases highlight the challenges of treatment and the importance of prompt diagnosis. [ABSTRACT FROM AUTHOR]

Botryomycosis has emerged as a multifaceted entity caused by both the aerobes as well as the anaerobes, however, the exact nature of this entity is not understood in entirety as there are varying reports pertaining to its association with other conditions, clinical presentations and the host’s immune status. In the present report we describe a case of granular bacteriosis in a 34 year old male patient with an unclear clinical presentation. The use of the term “granular bacteriosis” when there is misconstrued clinical and microbiologic presentation is the highlight of this paper and the isolated causative factor in the present case is Propionibacterium acnes ( P. acnes ). [ABSTRACT FROM AUTHOR]

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Botryomycosis is a rare pyogranulomatous disease characterized by suppurative and often granulomatous bacterial infection of the skin, soft tissues and viscera. Only about 90 cases have been reported in world literature till date: 75% of them are cases of cutaneous botryomycosis. Of the 18 reported cases of primary pulmonary botryomycosis, only one had histologically proven botryomycosis in a lung cavity. We report here a case of primary pulmonary botryomycosis occurring in a lung cavity, which is to the best of our knowledge first such case from India. The index case was a 62 year old female who presented to us with recurrent episodes of non-massive streaky hemoptysis with CT chest revealing ′Air Crescent′ sign with a probable fungal ball in a left upper lobe cavity. Left upper pulmonary lobectomy was done and histopathology of the cavitary tissue revealed Splendore-Hoeppli phenomenon and features suggestive of Botryomycosis. Tissue culture from the cavitary specimen grew Pseudomonas aeruginosa. Botryomycosis can mimic Aspergilloma radiologically as was seen in our case, but therapy is often a combination of both medical and surgical measures unlike Aspergilloma.

Background: Botryomycosis is a rare infectious disease which usually affects the skin. The low virulence of the bacteria tending to form grains and the immune status of the host are important factors in the development of the disease. Methods: We report a case of cervicofacial botryomycosis and review the current literature. Results: A 47-year-old male with a long history of moderate-to-severe atopic dermatitis presented with painful and suppurative nodules of the head and neck. A skin biopsy revealed granules consisting of Gram-positive bacterial colonies in a blossom-like assembly in the center and an eosinophilic rim in the periphery, which are pathognomonic features of botryomycosis. The lesions responded well to systemic antibiotics; however, they rapidly relapsed upon cessation of the treatment. Conclusions: We highlight the well-defined histologic features and recall an almost forgotten disease. We review common predisposing conditions and present evidence that atopic dermatitis might be an additional predisposing factor. © 2014 S. Karger AG, Basel

Botryomycosis is a rare bacterial infection that can involve the skin and viscera. It is multifocal in development, characterized by granulomatous bacterial infection. The organisms form granules, which are composed of bacterial masses that are adhered to each other. Here, we describe one unusual case of culture proved Staphylococcus aureus induced botryomycosis in patients with the acquired immune deficiency syndrome who was successfully treated.

Cutaneous botryomycosis is a chronic focal infection characterised by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus and occasionally Pseudomonas, Escherichia coli, Proteus, Streptococcus, etc. Early diagnosis and treatment with specific antibiotics alongwith surgical debridement is recommended. Cutaneous metastatic tuberculous abscess and scrofuloderma also presents as subcutaneous swellings and multiple discharging sinuses. A twenty two year old female patient presented with multiple erythematous subcutaneous lesions over lower back, buttocks and bilateral inguinal region, most of which were discharging purulent material since two years. This case is being reported because of the clinical dilemma it poses to the dermatologists. [ABSTRACT FROM AUTHOR]

Chronic pyo-granulomatous infection of subcutaneous tissues with recurrence and exacerbations are predominantly of bacterial origin in Southern India. Most of the infections may not present with the classic triad to be labeled as mycetoma. Frequently, granular discharge is absent or not elicited. More often the infection is monomicrobial. However, rare polymicrobial infections are posing challenges in the treatment of the same. The genus Alternaria belongs to phaeoid fungi infecting immunocompromised hosts. They are associated with cutaneous and subcutaneous infections (70-80%) predominantly. We recount a rare case of chronic subcutaneous mixed infection by Alternaria alternata and methicillin sensitive Staphylococcus aureus in a healthy, immunocompetent, non-diabetic woman. [ABSTRACT FROM AUTHOR]

A 65 year-old man with no remarkable medical history, presented to the emergency room with 5 months of intermittent growth of skin nodules that last about 2 months and heal spontaneously, associated with high spiking fevers, dyspnea, dry cough and 8 Kg weight loss. Physical examination demonstrated noteworthy cachexia, oral thrush, bibasal crackles and multiple non-tender subcutaneous nodules in the trunk and extremities. The nodules were erithemato-violaceous, necrotic and ulcerated, with copious discharge of purulent material (A, B). Computed tomography scans of the neck, chest and abdomen were normal except for patchy ground-glass infiltrates in the lungs. Laboratory data showed anemia 8.7 mg/dL, Leukopenia 2.1 cells/mL, a positive human immunodeficiency virus (HIV) serology, CD4 count of 27 cells/uL, and Silver-methenamine staining of bronchoalveolar lavage with Pneumocystis jirovecii cysts. Biopsy of the lesions was performed and optical microscopy examination with hematoxylin-eosin staining demonstrated epidermal acanthosis and dermal fibrosis with suppurative and chronic inflammation, eosinophilic, amorphous granules or grains containing clusters of nonfilamentous bacteria arranged in lobules (C), but no signs of malignant neoplasia or other microorganisms were informed, and bacterial cultures grew Staphylococcus aureus. According to these findings, the diagnosis of cutaneous botryomycosis was made, and intravenous antimicrobial therapy with Trimethoprim-Sulfamethoxazole was initiated, showing a dramatic improvement of the lesions after only 8 days of treatment (D), then the patient was discharged with oral antibiotic therapy with Trimethoprim-Sulfamethoxazole and antiretroviral medication.

Cutaneous botryomycosis is a chronic focal infection characterized by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus. Treatment requires antibiotic therapy and may also require surgical debridement. We employed topical heat therapy and oral minocycline. The lesions became flattened and pigmented after 1 month. We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

A probable case report of an abdominal botryomycosis has been hypothesized in a patient with a stable HIV infection under an effective antiretroviral therapy. Hyperpyrexia, abdominal pain and tenderness, and a thickening of small intestinal walls associated with multiple mesenteric adenopathies and a peritoneal involvement, prompted an ultrasonography-guided fine needle biopsy, and later a laparoscopy-laparotomy which excluded a neoplastic or lymphoproliferative disorders, showing only abundant fibrotic and necrotic-steatonecrotic tissue, with sparse multinuclear giant cells type Langhans. The prompt response to surgical intervention and a treatment with i.v. meropenem alone might be referred to a concurrent gram-negative infection of abdominal origin, until a late culture of an atypical Mycobacterium came to our attention over one month after the end of hospitalization. An updated literature search is presented and discussed, in relationship with the observed, extremely infrequent case reports of botryomycosis in different clinical settings.

Botryomycosis arises from chronic infections produced by low-virulence organisms in an altered host environment. Staphylococci have been the most common organisms implicated, but various other bacteria have also been identified in human botryomycosis lesions. The relative balance between the host′s resistance and the microorganism′s virulence may be altered in some way that perpetuates the growth of the lesions in a symbiotic fashion. The diagnosis of botryomycosis is one that is often easily overlooked because it can be confused with other mycetomas such as actinomycosis and nocardosis. We report here a case of micrococcal botryomycosis that occurred in the left temporal region in a 70 year-old male, which was diagnosed by the help of a histopathological examination and microbial cultures.

A middle aged woman presented to us with a localised well defined swelling of 3 months duration. It was located just below the lower eyelid punctum and was constantly discharging whitish granules. We suspected it to be arising from the lacrimal apparatus and posted the patient for Dacryocystectomy. On the operating table we found a swelling in the region of the lacrimal sac which was later excised. Histopathology revealed Botryomycosis and Chronic Dacryocystitis. Botryomycosis is a rare condition and requires a high index of suspicion to diagnose it. It is confirmed by histopathology and culture. Surgical debridement is the treatment of choice in such cases with an assessment of the immune status. Long term antibiotic treatment is required in all conditions as recurrence is common. [ABSTRACT FROM AUTHOR]

Botryomycosis is a rare, chronic granulomatous infection caused by a response to bacteria, most commonly Staphylococcus aureus. Cutaneous manifestations, such as subcutaneous nodules, nonhealing ulcers, or sinus tracks, typically occur following inoculation of bacteria after trauma. Drainage from the skin lesions may contain yellow grains resembling those seen in actinomycosis and nocardiosis. A 20-year-old Hispanic male presented over the course of several years with a chronic nonhealing left posterior scalp wound. A car hit the patient when he was 2 years old and injured the scalp in the location of the skin lesion. Multiple wound cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and biopsies were consistent with botryomycosis. He was treated with multiple surgical debridements, skin grafts, and various courses of oral and intravenous antibiotics with slight improvement. One reason for poor response to therapy was noncompliance with long-term home antibiotics. The most recent tissue culture grew MRSA in addition to Nocardia mexicana, and he experienced improvement on linezolid and minocycline. Although it is important to exclude nocardiosis and actinomycosis when diagnosing botryomycosis, our patient was diagnosed with botryomycosis after multiple biopsies and positive MRSA cultures 2 years prior to 1 positive N mexicana culture. Our case is a unique presentation of botryomycosis in an individual who subsequently developed Nocardia-positive wound cultures. [ABSTRACT FROM AUTHOR]

Botryomycosis is a rare chronic granulomatous bacterial infection involving mostly the skin and subcutaneous tissues. The nomenclature is a misnomer as it is caused by true bacteria and not by fungus. This uncommon infection sometimes simulates neoplasia and actinomycosis. Staphylococcus aureus is the agent isolated in most cases, followed by Pseudomonas sp. cepas. The authors present an uncommon case of invasive umbilical Botriomycosis simulating an acute abdome. A combination of surgery and antibiotic therapy treatment was applied with complete resolution of the infection. More often seen in the skin, this is the first report of Botryomycosis affecting this site.

The first two Uruguayan cases of botryomycosis were diagnosed in white adult male patients with cutaneous lesions. Staphylococcus aureus was the etiologic agent in both cases. In one of them, however, Pseudomonas aeruginosa was also identified during relapse. General comments on diagnosis and pathogenesis of the disease are made.Apresentamos os dois primeiros doentes de Botriomicose tegumentar no Uruguai. Ambos doentes eram adultos do sexo masculino. Um tinha lesão isolada abscedida. No outro as lesões eram múltiplas e algumas fistulizadas. Em ambos doentes o agente etiológico isolado foi Staphylococcus aureus. No primeiro doente, além disso, foi isolado Pseudomonas aeruginosa na recidiva. Comentários gerais são feitos sobre o diagnóstico e patogenia da doença.

Copyright of Foot Medicine & Surgery / Medecine et Chirurgie du Pied is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Botryomycosis is a rare infectious disease which usually affects the skin. The low virulence of the bacteria tending to form grains and the immune status of the host are important factors in the development of the disease. Methods: We report a case of cervicofacial botryomycosis and review the current literature. Results: A 47-year-old male with a long history of moderate-to-severe atopic dermatitis presented with painful and suppurative nodules of the head and neck. A skin biopsy revealed granules consisting of Gram-positive bacterial colonies in a blossom-like assembly in the center and an eosinophilic rim in the periphery, which are pathognomonic features of botryomycosis. The lesions responded well to systemic antibiotics; however, they rapidly relapsed upon cessation of the treatment. Conclusions: We highlight the well-defined histologic features and recall an almost forgotten disease. We review common predisposing conditions and present evidence that atopic dermatitis might be an additional predisposing factor. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This case report describes an unusual diagnosis of central nervous system botryomycosis in a horse. A 16-year-old Welsh Section D gelding was evaluated for acute onset of hypermetric ataxia, leaning to the left and head tilt to the right. Based on the neurological signs, a cerebellar lesion with accompanying vestibular disease was suspected and supportive therapy consisting of antimicrobial and glucocorticosteroid drugs and hypertonic saline was instituted. This resulted in marked clinical improvement over a 48 h period. Computed tomography performed in the standing, sedated horse following initial stabilisation identified extensive sclerosis and lysis of the right temporal and occipital bones, consistent with an infectious or neoplastic process. Based on the grave prognosis for survival despite the clinical improvement, euthanasia was undertaken. Post mortem magnetic resonance imaging identified a mass lesion impinging on the right cerebellar hemisphere, sclerosis of the temporal and occipital bones lateral and ventral to the mass, as well as destruction of the temporal bone between the inner ear and the cerebellum. These changes corresponded to the presence of a mass within the right dorsal temporal bone, extending into the right lateral temporal bone. The mass extended to compress and adhere to the right lateral hemisphere of the cerebellum. A histopathological diagnosis of botryomycosis was made, affecting the temporal and occipital bones and compressing the cerebellum. [ABSTRACT FROM AUTHOR]