Author Affiliations: University of Pennsylvania School of Medicine (Ms Nagler); and Departments of Dermatology (Drs Wanat and Rosenbach), Pathology and Laboratory Medicine (Drs Bachman, Elder, and Edelstein), and Department of Medicine, Infectious Disease Division (Dr Schuster), University of Pennsylvania, Philadelphia.
A 68-year-old man with acute myelocytic leukemia (AML) presented with neutropenic fever 12 days after induction chemotherapy with daunorubicin and cytarabine. Physical examination revealed scattered crusted erythematous papules in the groin (Figure 1). Empirical antimicrobial coverage was started with cefepime and voriconazole. A skin biopsy specimen demonstrated clusters of large, plump cocci infiltrating the dermis, associated with a hair follicle (Figure 2A-C). Gram stain of the biopsy specimen demonstrated large gram-positive cocci in pairs and tetrads. The isolated bacterium was identified using 16s ribosomal DNA sequencing as Kytococcus schroeteri, demonstrating 100% identity.1
Nagler AR, Wanat KA, Bachman MA, Elder D, Edelstein PH, Schuster MG, Rosenbach M. Fatal Kytococcus schroeteri Infection With Crusted Papules and Distinctive Histologic Plump Tetrads. Arch Dermatol. 2011;147(9):1121-1122. doi:10.1001/archdermatol.2011.242