To the Editor.
—We read with interest the case report by Alvarez-Elcoro and Sifuentes-Osorio1 in the April Archives. In our opinion, the primary emphasis of their report may be misleading. Specifically, the authors stated that their case was unusual in that the diagnosis was made by examination of the peripheral blood smear. Similar morphologic pathogens can not be excluded solely by the microscopic examination. Corynebacterium sp, Bacillus sp, Listeria sp, and Erysipelothrix sp also need to be included as differential possibilities in gram-positive rod bacteremia.Corynebacterium sp have assumed an increasing role as a cause of opportunistic infections, especially in immunocompromised patients and patients with implanted prosthetic material. The increasing prevalence of resistant Corynebacterium sp, with notable emergence of penicillin-resistant strains has recently been discussed.2We recently reported a case of Bacillus cereus myonecrosis that clinically and by Gram's stain criteria was classic for a clostridial gangrenous infection.
Johnson DA, Wagner KF. Antibiotic Therapy Based on Stained Peripheral Blood Smear. Arch Intern Med. 1985;145(2):369. doi:10.1001/archinte.1985.00360020213045