HAH. Babay, Pleural Effusion Due to Corynebacterium Propinquum in a Patient with Squamous Cell Carcinoma. 2001; 21(5-6): 337-339 Corynebacterium propinquum (C. propinquum) is part of the normal oropharyngeal flora. Originally called CDC coryneform ANF-3 (absolute nonfermenter), it was Riegel et al. in 1993 who proposed the name C. propinquum. 1 On gram stain, it shows corynebacterial forms after 24 hours' incubation on sheep blood agar. Colonies appear whitish, nonhemolytic and 1-2 mm in diameter with a matted surface. C. propinquum is nonlipophilic, catalase positive, reduces nitrate and hydrolyzes tyrosine, but does not hydrolyze urea or esculin, and also does not ferment sugars. CAMP test for the organism is usually negative.2 Clinical infections by C. propinquum are rare. There has only been one previously reported case of native valve endocarditis due to Corynebacterium ANF-3, in 1994, 3 but there have been no reports of this organism as a causative agent of lower respiratory tract infection in the English and non-English literature over the last 20 years. In this report, we describe a case of pleural effusion which grew C. propinquum in a patient with squamous cell carcinoma of the lung. The organism was multiresistant to penicillin, cefuroxime, gentamicin, erythromycin, clindamycin, rifampicin and vancomycin, but sensitive to ceftriaxone, ciprofloxacin, imipenem, tetracycline, and sulfamethoxazole-trimethoprim. To our knowledge, this is the second reported case of clinically significant C. propinquum infection. Case ReportA 70-year-old Saudi male was admitted to King Khalid University Hospital, Riyadh, in August 2000, with complaints of cough, shortness of breath, right-sided chest and abdominal pain of one year's duration. The patient had a history of fever, weight loss, hemoptysis and cough, for which he had been seen at different clinics with no definitive diagnosis made. He had no history of previous admission to hospital or treatment with antibiotics. On admission, he looked pale, cachectic, and had finger clubbing. His temperature was 38°C. Chest auscultation revealed right basal crepitation, and he also had tenderness in the right hypochondrium. Blood investigation showed a leukocyte count of 21.70 x 10 9 /L with 91% neutrophils, hemoglobin of 8.4 g/L and ESR of 113 mm/hour. Chest xray showed right pleural effusion. Blood culture was taken, and 400 mL of pus was aspirated from the pleural effusion, which showed a leukocyte count of >200,000/mm 3 , with 100% polymorphs, and red blood cells of 160/mm 3 . Gram stain showed gram-positive coryneform-like bacilli. Ziehl-Neelsen staining for acid-fast bacilli was negative.The patient was started on ceftriaxone 2 g intravenously per day and 500 mg metronidazole 8 hourly. On day four, ultrasound of the liver and lung revealed thick wall pleural effusion and a collection in the liver, with a possible diagnosis of liver abscess. Brain CT scan showed two-ring lesions, which could either have been brain abscess or metastasis. An intercostal chest tube was i...

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Brucellosis remains endemic in many countries including Saudi Arabia. The disinfection of objects and surfaces contaminated with Brucella spp is not difficult, but we encountered a situation in which the organism survived the decontamination and liquefaction procedure adopted for AFB culture. A sputum specimen from a patient was sent for TB culture and the BACTEC MGIT 960 system isolated an organism identified as Brucella spp. The blood cultures and the serological testing had confirmed this case to be brucellosis. Isolation of Brucella spp from sputum samples is rare; this case appears to be the first of its kind. As the clinical presentation of TB may mimic brucellosis and vice versa, we recommend that handling specimens from all cases of undiagnosed PUO should be done with care because of the possibility that it may contain either of these organisms.