40/M Australian immigrant, w/ 3 wks tender 5x5cm suppurative LN R axilla, (-)rash/fever. 4 mos ago, milder episode Tx w/ 10d abx. S/p surgery & LN path: caseating granuloma. Multiple tissue Cx: Gram+ bacilli, (-)AFB. Worked in a sheep farm, (+)cats, (-)trauma. Most likely cause?
(1/5) 14% got the right answer, Corynebacterium. Case of Corynebacterium pseudotuberculosis. Primary pathogen of sheeps/goats. Human infection results from exposure to infected sheeps/goats. First case in humans reported in 1966 academic.oup.com/ajcp/article/4… #IDMedEd
(2/5) Human infection marked by regional lymphadenitis (axillary most common), often suppurative (extremity rash/wound can be see but uncommon); responds w/ antibiotics but notorious for recurrence; Tx: long course of antibiotics + lymph node excision. #IDMeEd
(3/5) Lymph node path shows necrotizing (caseating) granuloma. The majority of cases reported in Australia. #IDMedEd Further reading: ncbi.nlm.nih.gov/pubmed/9114145
(4/5) Another species of Corynebacterium was quizzed before: granulomatous mastitis secondary to Corynebacterium kroppenstedtii. #IDMedEd. See link below to review:
(5/5) Presents similarly as Bartonella, a (Gram neg rod). We talked about this recently: . Review another Gram+ rod that causes lymphocutaneous cellulitis we covered more recently #idmed
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