PMC5788053_01
(A) Photo of the nodular rash (indicated by black arrows) on the left thigh. (B) Echocardiogram in the apical 4-chamber view showing a large circumferential pericardial effusion (indicated by a white arrow). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
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F1
A 20-year-old student with no past medical history was seen in the emergency department (ED) for a painful, nodular rash on his left thigh (Figure 1A). Exam was notable for a temperature of 38.4 C, tachycardia, distended neck veins, and 2 erythematous nodules on his left thigh. Echocardiogram demonstrated a large pericardial effusion with evidence of tamponade (Figure 1B and Video 1).
(A) Gram stain of the curved Gram-negative rod using carbol fuchsin as the counterstain and (B) acridine orange stain.
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F2
Two days after collection, his blood and pericardial cultures grew a curved Gram-negative rod that was difficult to visualize on Gram stain but easily seen with carbol fuchsin counterstain (Figure 2A) and acridine orange stain (Figure 2B).