PMC9830148_01
Axial (left) and coronal (right) views of contrasted computerized tomography of left hand revealing soft tissue ulceration along the ulnar aspect of wrist/proximal hand with subjacent cellulitis and an ill-defined intramuscular abscess extending from the ulceration into the hypothenar musculature.
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At the time a contrasted computerized tomography (CT) of her left upper extremity revealed soft tissue ulceration with cellulitis extending into an ill-defined intramuscular abscess (Fig. 1).
Coronal (left) and axial (right) views of contrasted computerized tomography of right shoulder revealing large lobular, multi loculated collections throughout the shoulder involving the rotator cuff musculature both anterior and posterior to the scapula. Moderate amount of fluid within the subacromial bursa and associated punctate densities concerning for subacromial bursitis as well as moderate glenohumeral joint effusion concerning for septic arthritis are also seen.
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Imaging on arrival included a contrasted CT of her right shoulder revealing multi loculated collections throughout the shoulder concerning for abscesses, moderate fluid within subacromial bursa concerning for bursitis, as well as moderate glenohumeral joint effusion concerning for septic arthritis (Fig. 2).
Thin beaded branching Gram positive bacilli seen on Gram stain of right shoulder synovial fluid (left) and periscapular abscess (right).
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Gram stain of the fluid revealed gram positive beaded bacilli and culture grew N. farcinica (Fig. 3).
Two axial views of computerized tomography of chest revealing scattered areas of tiny nodules (left and right), bibasilar effusions (right) and bibasilar posterior infiltrates (right).
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Noncontrasted CT of her chest showed small bibasilar effusions and bibasilar infiltrates as well as small scattered nodularity with no abscesses (Fig. 4).