Infectious Diseases Case of the Month

Gram Stain

Photo from CDC Public Health Image Library

A 27 y.o. hispanic female was seen in infectious diseases clinic for a 4 week history of fevers, chills, sweats, and a five to ten pound weight loss. She denied localizing symptoms including cough, rash, abdominal pain, vomiting, joint pain, or dysuria. Examination was largely benign although there was moderate tenderness in the epigastrium and left upper quadrant of her abdomen.

A native of Mexico, she was married and had lived in North Central Washington for the previous ten years. Other family members were not ill. Five or six months prior to her illness she had undergone a Billroth Type I partial gastrectomy for gastric adenocarcinoma. This surgery was performed in Mexico and she convalesced there until her return two months prior to the onset of her current illness. While convalescing in Mexico she consumed quite a bit of cheese; she was unsure as to whether it was pasteurized.

Laboratory evaluation included WBC 4.3 (L), Hgb 11.2 (L), Plts 247, Alk Phos 141 (H), AST 55 (H), T Bili 0.4. CT scans of abd and chest were notable only for post gastrectomy changes.

Two blood cultures became positive after four to five days of incubation. Gram stain of organisms cultured from blood was similar to the one pictured at left.

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