Actinobaculum schaalii, which belongs to the group of Gram-positive rods, is difficult to culture. Using molecular genetics, Actinobaculum schaalii could be identified as a causing microorganism in a case of Fournier's gangrene. CASE REPORTA 33-year-old man was presented at the emergency ward with fever (37.8°C) and pain and swelling in the left groin area. He was an obese smoker (body mass index [BMI], 36) suffering from diabetes mellitus. Radiological examination revealed an important infiltration of the cutis and subcutis in both the left and right groin area up to the scrotum. Air bubbles were present. Blood analysis showed a C-reactive protein level of 33.6 mg/dl and a leukocyte count of 20.3 ϫ 10 9 /liter (85.9% neutrophils). Blood cultures were negative.

We report a case of apparent malaria infection presented with a syndrome of painless, generalized lymphadenopathy without granulomas shortly after exposure to fresh water in rural West Africa. Residual infection with Massilia timonae was diagnosed and successfully treated with co-trimoxazole. CASE REPORTA 52-year-old man, born in Nigeria and living in Belgium since 1996, was admitted to our hospital with a 7-day history of fever, myalgia, and lymphadenitis. The fever was intermittent, with spikes of fever following chills on alternating days. Two weeks earlier, he had returned from a 2-month visit to his family in Nigeria. He did not take any malaria prophylaxis and reported swimming in a lake outside Lagos. Once returned in Belgium, he continued his usual life as an unemployed person, spending most of his time indoors. His medical history revealed diabetes mellitus and previous malaria.At the time of admission, the patient was conscious and alert; he had a temperature of 38.5°C, a pulse rate of 120 beats/min, and blood pressure of 120/80 mm Hg. Physical examination revealed multiple firm and nontender cervical, axillary, and inguinal lymphadenopathies, with a size up to 2 cm. Abdominal examination showed tenderness in the right upper quadrant. The rest of the physical examination was unremarkable. Hematological investigations showed a hemoglobin level of 11.5 g/dl (reference values, 12.9 to 16.4 g/dl), a platelet count of 69 ϫ 10 9 /liter (reference values, 142 ϫ 10 9 to 340 ϫ 10 9 / liter), and a total leukocyte count of 13.1 ϫ 10 9 /liter (reference values, 3.45 ϫ 10 9 to 9.76 ϫ 10 9 /liter) with a normal differentiation. Biochemical investigations were normal, except for mildly elevated lactic dehydrogenase (LDH) (790 U/liter [reference values, 313 to 618 U/liter]) and elevated C-reactive protein (CRP) (30 mg/dl [reference value, Ͻ0.5 mg/dl]). A rapid diagnostic test (RDT) for malaria (BinaxNOW malaria test; Inverness Medical Binax, Inc., Scarborough, ME) was positive for Plasmodium falciparum protein antigen. According to the manufacturer, the overall sensitivity for P. falciparum of the BinaxNOW malaria test in an endemic population is 95.3% (95% confidence interval [CI], 93 to 97%) and the overall specificity for the same antigen is 99.8% (95% CI, 99 to 100%). Similar performance characteristics of the test were found in rounds 1 and 2 of the WHO RDT testing scheme (sensitivity, 100% in high-parasite density samples; specificity, 95%). Blood and urine cultures were sterile. Computed tomography scans were performed and showed diffuse lymphadenopathies with a diameter of 2 to 3 cm in the cervical, mediastinal, axillary, and pelvic regions. The liver and spleen were normal in size.The patient was treated for malaria with oral quinine (1,500 mg daily) and doxycycline (100 mg twice daily) for 7 days. The clinical state of the patient improved, and he became afebrile within 3 days.The enlargement of the lymph nodes persisted, and therefore a biopsy of a cervical lymph node was performed 2 weeks later. Histocyt...

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