Division of Infectious Diseases

Case of the Month - November 2017

Case of the Month  - November 2017

 

A 35 year old woman with a history of breast abscesses went to the Emergency Room for several days of right breast pain, itching, and a rash.  She noted that the breast pain had started several days after she began taking clindamycin for a dental abscess. 

  

On physical exam, her right breast was warm, tender, erythematous, and swollen. 

  

An incision and drainage was performed and a bacteriology culture was sent.  The Gram stain revealed 4+ white blood cells, 3+ Gram-positive cocci in pairs and clusters, and 1+ Gram-positive branching bacilli.  After 48 hours of incubation, many pinpoint, white, non-hemolytic colonies were observed on blood agar, chocolate, and colistin-nalidixic plates.  This same bacterial species had grown from drainage from a left breast abscess in 2016.  Since MALDI has been used, this species has been increasingly identified in wound and blood cultures. 

  

What is this aerotolerant, Gram-positive bacilli that can cause clinically significant skin infections? 

 Send answers to Dr. Ira Leviton, ileviton@montefiore.org. 
 

Nov 21017-a
 Figure 1 - Gram stain of abscess with many white blood cells, Gram-positive cocci, and Gram-positive bacilli 

Nov 21017-b  

Figure 2 - Growth of non-hemolytic pinpoint colonies aerobically. 

 

 

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