Complaint Two patients come in with related complaints: Patient A complains of a draining neck lesion and fever. He says he noticed a swelling in his neck a few weeks ago that started to drain out to the skin yesterday. Patient B complains of chest lesions and fever. He has pneumonia-type symptoms (productive cough, fever, chest pain) that started a few weeks ago, followed by the development of left chest wall lesions. History Patient A has a history of tooth extraction and poor dental hygiene. Otherwise, there is no significant past medical history Patient B is immunocompromised because of lymphoma and chemotherapy. Physical Exam Patient A: Exam reveals fever (102°F [39°C]) and a swollen, indurated lesion near the angle of the jaw with pus draining from a sinus tract leading from the skin into the lesion. Patient B: Exam reveals fever (102°F [39°C]) and fluctuant subcutaneous abscesses in the anterior left chest wall. Auscultation reveals decreased breath sounds and signs of consolidation in the underlying lung. Tests Examination of material from neck and chest lesions: Patient A: gram-positive rods with long, branching filaments. Sulfur granules present. Anaerobic culture positive Patient B: gram-positive rods with long, branching filaments. Organism weakly acid-fast and no sulfur granules noted. Aerobic culture positive
