PMC8486024_01
(a) Clinical photograph showing eyelid edema and inflamed canalicular mucosa pouting through the punctum (arrow); (b) Smear showing gram-positive branching filamentous organisms, gram-positive cocci in short chains and pairs and numerous gram-negative bacilli (arrows) throughout (Gram stain, x100); (c) Confluent alpha hemolytic pin point colonies at the site of inoculation on blood agar; (d) Identification of the organism as Sphingomonas paucimobilis by Vitek 2 Compact identification system
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F1
On examination, there was erythematous swelling of the medial third of the lower eyelid and an inflamed pouting punctum [Figure 1a]. Gram's staining of the canalicular contents revealed numerous gram-positive branching filamentous organisms and groups of gram-positive cocci in pairs and short chains among a large number of gram-negative coccobacilli [Figure 1b]. On aerobic culture, confluent pin-point alpha-hemolytic colonies and confluent translucent gray colonies grew on blood and chocolate agar at the site of inoculation [Figure 1c]. Streptococcus species, Sphingomonas paucimobilis [Figure 1d], and Actinomycetes species. Streptococcus and Sphingomonas were sensitive to all antibiotics [Table 1], but Actinomycetes species showed multidrug resistance.
PMC8486024_02
(a) Few gram-negative bacilli (arrows) in a background of plenty polymorphs (Gram stain, x100); (b and c) Discrete, small, pale yellow colored colonies at the site of inoculated concretions on blood and chocolate agar; (d) Identification of the organism as Myroides species by Vitek 2 compact identification system
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F2
Gram's staining of smears from the concretion revealed plenty of polymorphonucleocytes with few gram-negative bacilli per oil immersion field [Figure 2a]. On aerobic culture, growth of discrete, pale yellow colored colonies [Figure 2b and c] at the site of inoculation and the organism was identified as Myroides species by Vitek 2 Compact identification system [Figure 2d] which was multidrug resistant [Table 1] but sensitive to chloramphenicol.
PMC8486024_03
Nonhemolytic non-pigmented small gray colonies of Brucella melitensis on blood agar
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F3
Nonhemolytic nonpigmented small gray colonies [Figure 3] grew on blood agar.
PMC8486024_04
Subtle lower eyelid edema and discharge in the patient with Leuconostoc infection
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F4
There was mild edema at the site of the punctum [Figure 4].