Periodic acid-Schiff-positive organisms in primary cutaneous Bacillus cereus infection. Case report and an investigation of the periodic acid-Schiff staining properties of bacteria.
Primary cutaneous Bacillus cereus infection frequently presents as a single necrotic bulla on the extremity of an immunocompromised patient. In lesional biopsy specimens and smears, the large gram-positive rods of B cereus may be mistaken for Clostridium species. This is a potentially serious error, as Bacillus species are resistant to penicillin and other beta-lactam antibiotics. We studied a case in which large periodic acid-Schiff-staining organisms were seen in the biopsy specimen from a necrotic bulla on the finger of a neutropenic patient with diffuse large cell lymphoma. The tissue biopsy specimen subsequently yielded a pure culture of B cereus. Staining with periodic acid-Schiff was then performed on a series of bacterial species in human tissue and from smears of culture colonies. The following bacterial species were found to be consistently periodic acid-Schiff positive after diastase digestion: B cereus, Corynebacterium diphtheriae, Propionibacterium acnes, Klebsiella pneumoniae, and Micrococcus luteus.
Khavari
P A
PA
Department of Dermatology, Yale University School of Medicine, New Haven, Conn 06510.
Bolognia
J L
JL
Eisen
R
R
Edberg
S C
SC
Grimshaw
S C
SC
Shapiro
P E
PE
D000368:Aged; D001409:Bacillus cereus / Q000302:isolation & purification*; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010503:Periodic Acid-Schiff Reaction; D012874:Skin Diseases, Infectious / Q000175:diagnosis*