Presentation
A 15-year-old female with a history of cerebral palsy, dystonia and placement of a deep brain stimulator 9 years ago, with a recent pulse generator change 8 months ago, presents with pain, swelling, pruritus and erythema in the left post auricular region and along the extension wire tract. Her head CT showed no signs of meningitis, empyema, cerebritis or abscess. Due to clinical concern for infection, the patient had the entire deep brain stimulator removed. The operative report showed purulence at the site of incision and around the connector between the lead and extension. Aspirate from the surgery was sent to the microbiology lab for culture. Over time, the initially black, moist and shiny colonies began to develop aerial hyphae and transitioned to a fuzzy colony morphology within 4 weeks of growth. The organism could not be identified through morphology and MALDI-TOF. The internal transcribed spacer region of the organism was sequenced, and then an identification was made.
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Author Information
Hannah Moorman, M.D., Anatomic and Clinical Pathology Resident, PGY-2, Virginia Commonwealth University Health System.
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