Periodic Acid-Schiff-Positive Organisms in Primary Cutaneous Bacillus cereus Infection

Authors:
  • PKPaul A. Khavari
    Paul A. Khavari
  • JBJean L. Bolognia
    Jean L. Bolognia
  • RERichard Eisen
    Richard Eisen
  • SEStephen C. Edberg
    Stephen C. Edberg
  • SGSusan C. Grimshaw
    Susan C. Grimshaw
  • PSPhilip E. Shapiro
    Philip E. Shapiro
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Abstract
•Primary cutaneousBacillus cereusinfection 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 forClostridiumspecies. This is a potentially serious error, asBacillusspecies are resistant to penicillin and other β-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.