Our case also had a history of trauma secondary to a fall 3 months prior to the patient's hospital presentation. The duration between her first presentation and this occasion was 17 months. Pure cultures support a possible disease association, and the predominance of coryneform bacteria in material from normally sterile sites should also be considered an indicator for a possible disease association (4). These showed no growth after 5 days. She had been treated with flucloxacillin with no improvement. He denied any fever or night sweats, and there had been no significant weight loss. Leave these as-is. Granulomatous lobular mastitis is an inflammatory breast disease of unknown etiology that generally affects women of child-bearing age within a few years of giving birth (8). We also thank Helen Heffernan and Rosemary Woodhouse at ESR, Kenepuru, for doing the broth microdilution tests. Five weeks after the patient's initial presentation, there was a recurrence of swelling in her right breast. In our case, despite the bacteria being seen on a Gram stain, it took over 24 h for the initial isolate to grow. A further horse blood agar plate and a neomycin blood agar plate were inoculated for extended anaerobic incubation of 7 days. Clinically, it may present as a hard mass resembling a malignancy or as a firm, red, tender lesion suggestive of an abscess. Although she described having tenderness in the lower inner quadrant of her right breast 2 months later, clinically, her breast felt normal and there was no sign of an abscess. She was then 37 weeks pregnant. Isolates of this species have been susceptible to penicillin, cephalosporins, erythromycin, clindamycin, tetracycline, and the aminoglycosides, but they are resistant to sulfamethoxazole (5). It is likely that the organisms isolated, initially reported as skin flora, were indeed nonpathogenic and hence insignificant. American Society for Microbiology Endocarditis of native aortic and mitral valves due to this agent has been described. Despite the uncertainty, it is important to consider Corynebacterium species causative organisms in abscesses, especially when isolated as a pure or predominant growth of >104 CFU/ml. Pus (3 ml) was again aspirated, and routine bacteriological culture did not identify any organism, nor were there any acid-fast bacilli isolated on MGIT broth (Becton Dickinson Microbiology Systems, United Kingdom). The isolate was susceptible to penicillin (10 U), erythromycin (15 μg), vancomycin (30 μg), ciprofloxacin (5 μg), ceftriaxone (30 μg), and tetracycline (30 μg), using Clinical Laboratory Standards Institute (CLSI) interpretive criteria set for Staphylococcus spp. There was no United Kingdom interpretative guide for breakpoints or zone diameters for corynebacteria specifically until recently, when the BSAC published breakpoints for corynebacteria using BSAC susceptibility methods (1). Funke et al. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. When the patient was given a penicillin-based drug on a few occasions, she failed to respond. Ultrasound showed a 40-mm multilocular abscess cavity in the upper outer quadrant of her right breast. Like most other corynebacteria, C. accolens is pyrazinamidase positive, but alkaline phosphatase is not produced. 1991 was previously known as CDC coryneform group G-1. The patient then had a formal incision to allow drainage of the abscess at the same time that she was under general anesthesia for an elective caesarean section. Microbiological tests should include identification to the species level and susceptibility testing. Enter multiple addresses on separate lines or separate them with commas. We thank clinicians, laboratory scientists, and radiologists for their involvement in this case. Corynebacterium accolens, a benign lipid-requiring species, inhibits pneumococcal growth during in vitro cocultivation on medium supplemented with human skin surface triacylglycerols (TAGs) that are likely present in the nostrils. However, when repeatedly isolated, or isolated from a sterile site, or in pure culture, it is very likely to be clinically significant. recently published a review suggesting a link with Corynebacterium infection, particularly with C. kroppenstedtii. This inhibition depends on LipS1, a TAG lipase necessary for C. accolens growth on TAGs such as triolein. The patient in our case was also given empirical flucloxacillin upon admission, which may have slowed the rate of recovery. It's a trap for spambots! The specimen was plated (i) onto horse blood agar (Oxoid, Basingstoke, United Kingdom) and incubated at 35°C both with 5% CO2 in air and anaerobically, (ii) onto MacConkey agar (Oxoid) and incubated at 37°C in air, and (iii) onto neomycin blood agar and incubated anaerobically at 37°C. This is consistent with other reports (1, 4) that C. accolens is a slow-growing bacterium species.

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