A 68-Year-Old Man With Follicular Lymphoma Presenting With Fever and Chills - QUIZ

Figure 1. Gram stain from isolated colony from the blood agar plate (magnification 3 X 1000).

A 68-year-old man from southeast Ohio with a history of follicular lymphoma, diverticulosis, and sinusitis presented to our medical center in December 2010 with complaints of 3 weeks of productive cough, dyspnea, fever, and chills. He denied travel or exposure to sick contacts. He was  an avid hunter of deer and rabbits and owned hunting dogs. He had an annual gathering with other hunters where they ate numerous game meats including gator, bear, elk, moose, and deer. On examination, he appeared weak and fatigued. He was afebrile, tachypneic, tachycardic, and hypotensive with an oxygen saturation of 87% on room air. Pulmonary examination revealed bibasilar crackles. Initial chest x-ray showed a subtle air space disease in the left upper lobe concerning for evolving pneumonia. His peripheral white count was 30 200 cells/lL, with neutrophils 84%, lymphocytes 4%, and monocytes 10%. He was started initially on empiric vancomycin and piperacillin/tazobactam for sepsis secondary to pneumonia. He continued to improve in the hospital while on antibiotics. The anaerobic blood cultures drawn on admission and prior to antibiotic administration were positive. The Gram stain from the colonies growing in the blood agar plate incubated anaerobically is shown in the Figure 1. The motility based on the hanging drop test was positive. Based on the anaerobic growth, Gram stain, and the hanging drop test, what is your diagnosis? How would you treat this patient?

Clinical Infectious Diseases 2012;54(1):95