Primary pulmonary botryomycosis presenting with septic shock and acute lung injury.

Botryomycosis is a rare chronic suppurative bacterial infection involving mostly subcutaneous tissues and less frequently other organs. It can be diagnosed by histological examination and culture of the granules. Botryomycosis is mostly caused by Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa but the exact pathogenesis remains uncertain. Treatment often requires a combination of both surgical debridement and long-term antimicrobial therapy. The patient is a young woman known to have Down's syndrome. She had a dramatic presentation with septic shock and acute lung injury with persistence of pulmonary sepsis postoperatively. The importance of postoperative critical care is illustrated by this case in which a young patient underwent major surgery while septic and haemodynamically unstable. According to our research this is the first case of pulmonary botryomycosis reported in Down's syndrome and the first case which developed septic shock requiring vasoactive drugs and ventilation in the intensive care unit.