LAUSR

A previously well middle-aged woman presented to the emergency room following a nonsyncopal fall at home. On examination, she appeared comfortable, with normal hemodynamic parameter values. Unexpectedly, a grade 3/6 pansystolic murmur was heard at the cardiac apex, radiating to the axilla. She was afebrile and not in heart failure. Further detailed examination revealed a red, inflamed skin lesion over her right ring finger, which she had pricked while cleaning the fins of a fish 10 days earlier. No peripheral stigmata of infective endocarditis were identified. Transthoracic echocardiography showed severe mitral regurgitation with multiple vegetations on the aortic and mitral valves, confirmed subsequently on transesophageal echocardiography. Blood was collected and inoculated into two pairs of Bactec Plus Aerobic/F and Bactec Plus Anaerobic/F culture bottles and incubated in a Bactec 9240 system. Treatment with empirical antibiotics was commenced. Both sets of cultures were flagged positive after 1 day. Subcultures performed on Trypticase soy agar with 5% sheep blood displayed pure growth after 24 h. Subcultures on MacConkey agar and CDC anaerobic 5% sheep blood agar produced no growth. The appearance of growth on sheep blood agar at 4 days, examination under microscopy with Gram staining, and inoculation of Kligler’s iron agar (Fig. 1A, B, and C, respectively) led to the identification of the causative microorganism. Citation Chin CY, Huang Z, Sim JHC, Tan BY. 2018. Photo Quiz: A fishy tale of endocarditis. J Clin Microbiol 56:e00885-16. https://doi.org/10 .1128/JCM.00885-16. Editor Paul Bourbeau Copyright © 2018 American Society for Microbiology. All Rights Reserved. Address correspondence to Chee Yang Chin, [email protected]. For answer and discussion, see https://doi.org/10 .1128/JCM.00886-16 in this issue. FIG 1 (A) Pure growth of bacterial colonies on a 5% sheep blood agar plate (BAP) after 4 days. (B) Gram stain of colonies isolated from the BAP. (C) Kligler’s iron agar after inoculation. PHOTO QUIZ