crossmark
Photo Quiz (For answer and discussion, see page 1177 in this issue [doi:10.1128/JCM.00852-14].)
A Man with Fever and Cough Qinfang Qian,* Grigoriy Urman, Terra Cederroth, Robert Najarian, James E. Kirby Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
10 m
B
A
D
C
FIG 1 Individual organisms (arrows) seen on Gram stain (A) and KOH-calcofluor white stain (B) of a bronchoalveolar lavage sample and H&E (C)- and GMS (D)-stained sections of autopsy lung tissue.
A
40-year-old man with no significant past medical history developed fever, dry cough, night sweats, chills, and malaise 1 week after hiking in the mountains in Michigan. He visited his primary care physician (PCP) and was treated with oral azithromycin for 5 days with no improvement. The patient then traveled to Europe for 2 weeks. During this trip, he had daily fevers, chills, cough, and sweats. After returning to Massachusetts, he went to the emergency department, where a chest X-ray examination showed diffuse bilateral airspace consolidation. He was admitted to our hospital and initially treated with levofloxacin, vancomycin, and cefepime for presumptive community-acquired pneumonia. His white blood cell count was 20.8 ⫻ 103 cells/mm3 (normal range, 4 ⫻ 103 to 11 ⫻ 103 cells/mm3), with 86.6% neutrophils (normal range, 50 to 70% neutrophils), 7.4% lymphocytes (normal range, 18 to 42% lymphocytes), 5.2% monocytes, 0.3% eosinophils, and 0.5% basophils. Organisms of 8 to 10 m in diameter were seen on Gram (Fig. 1A) and KOH-calcofluor white (Fig. 1B) stain preparations of bronchoalveolar lavage and spu-
April 2016 Volume 54 Number 4
tum samples. The patient was subsequently treated with antimicrobial agents appropriate for these findings. Despite intensive medical therapy, the patient developed acute respiratory distress syndrome (ARDS) and expired. Histological preparations of autopsy lung tissue samples stained with hematoxylin and eosin (H&E) (Fig. 1C) or Gomori methenamine silver (GMS) (Fig. 1D) showed the same organism morphology. What is your diagnosis?
Citation Qian Q, Urman G, Cederroth T, Najarian R, Kirby JE. 2016. A man with fever and cough. J Clin Microbiol 54:825. doi:10.1128/JCM.00851-14. Editor: P. Bourbeau Address correspondence to Qinfang Qian, [email protected]. * Present address: Qinfang Qian, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Journal of Clinical Microbiology
jcm.asm.org
825
Photo Quiz (For answer and discussion, see page 1177 in this issue [doi:10.1128/JCM.00852-14].)
A Man with Fever and Cough Qinfang Qian,* Grigoriy Urman, Terra Cederroth, Robert Najarian, James E. Kirby Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
10 m
B
A
D
C
FIG 1 Individual organisms (arrows) seen on Gram stain (A) and KOH-calcofluor white stain (B) of a bronchoalveolar lavage sample and H&E (C)- and GMS (D)-stained sections of autopsy lung tissue.
A
40-year-old man with no significant past medical history developed fever, dry cough, night sweats, chills, and malaise 1 week after hiking in the mountains in Michigan. He visited his primary care physician (PCP) and was treated with oral azithromycin for 5 days with no improvement. The patient then traveled to Europe for 2 weeks. During this trip, he had daily fevers, chills, cough, and sweats. After returning to Massachusetts, he went to the emergency department, where a chest X-ray examination showed diffuse bilateral airspace consolidation. He was admitted to our hospital and initially treated with levofloxacin, vancomycin, and cefepime for presumptive community-acquired pneumonia. His white blood cell count was 20.8 ⫻ 103 cells/mm3 (normal range, 4 ⫻ 103 to 11 ⫻ 103 cells/mm3), with 86.6% neutrophils (normal range, 50 to 70% neutrophils), 7.4% lymphocytes (normal range, 18 to 42% lymphocytes), 5.2% monocytes, 0.3% eosinophils, and 0.5% basophils. Organisms of 8 to 10 m in diameter were seen on Gram (Fig. 1A) and KOH-calcofluor white (Fig. 1B) stain preparations of bronchoalveolar lavage and spu-
April 2016 Volume 54 Number 4
tum samples. The patient was subsequently treated with antimicrobial agents appropriate for these findings. Despite intensive medical therapy, the patient developed acute respiratory distress syndrome (ARDS) and expired. Histological preparations of autopsy lung tissue samples stained with hematoxylin and eosin (H&E) (Fig. 1C) or Gomori methenamine silver (GMS) (Fig. 1D) showed the same organism morphology. What is your diagnosis?
Citation Qian Q, Urman G, Cederroth T, Najarian R, Kirby JE. 2016. A man with fever and cough. J Clin Microbiol 54:825. doi:10.1128/JCM.00851-14. Editor: P. Bourbeau Address correspondence to Qinfang Qian, [email protected]. * Present address: Qinfang Qian, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Journal of Clinical Microbiology
jcm.asm.org
825
