Emerging Infectious Disease ISSN: 1080-6059

Recurrent Granulibacter bethesdensis Infections and Chronic Granulomatous Disease

David E. Greenberg

, Adam R. Shoffner, Adrian M. Zelazny, Michael E. Fenster, Kol A. Zarember, Frida Stock, Li Ding, Kimberly R. Marshall-Batty, Richard L. Wasserman, David F. Welch, Kishore Kanakabandi, Dan E. Sturdevant, Kimmo Virtaneva, Stephen F. Porcella, Patrick R. Murray, Harry L. Malech, and Steven M. Holland

Author affiliations: Author affiliations: National Institutes of Health, Bethesda, Maryland, USA (D.E. Greenberg, A.R. Shoffner, A.M. Zelazny, M.E. Fenster, K.A. Zarember, F. Stock, L. Ding, K.R. Marshall-Batty, P.R. Murray, H.L. Malech, S.M. Holland); University of Texas Southwestern Medical Center, Dallas, Texas, USA (R.L. Wasserman, D.F. Welch); Children's Medical Center, Dallas (D.F. Welch); Medical City Dallas Hospital, Dallas (D.F. Welch); National Institutes of Health, Hamilton, Montana, USA (K. Kanakabandi, D.E. Sturdevant, K. Virtaneva, S.F. Porcella)

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Figure 1

Radiologic and histologic findings for patients with Granulibacter bethesdensis infections. A) Contrast-enhanced computed tomography (CT) image for patient 2, showing enlarged epigastric nodes (arrow) in the abdomen. B) Contrast-enhanced CT image for patient 3, showing lymphadenopathy (arrow). The heterogeneity of the lymph node suggests necrosis. C) Noncontrast CT image of the spine for patient 4, showing enlarged cervical lymph nodes (arrow). D) Contrast-enhanced CT image for patient 5, showin

Figure 1. Radiologic and histologic findings for patients with Granulibacter bethesdensis infections. A) Contrast-enhanced computed tomography (CT) image for patient 2, showing enlarged epigastric nodes (arrow) in the abdomen. B) Contrast-enhanced CT image for patient 3, showing lymphadenopathy (arrow). The heterogeneity of the lymph node suggests necrosis. C) Noncontrast CT image of the spine for patient 4, showing enlarged cervical lymph nodes (arrow). D) Contrast-enhanced CT image for patient 5, showing a left supraclavicular mass. Arrow highlights an area suggestive of necrosis. E) Hematoxylin and eosin–stained section from patient 4, showing necrotizing granulomatous inflammation in the excised node (original magnification ×10). F) Hematoxylin and eosin–stained section from patient 2, showing necrotizing granulomas composed of epithelioid histiocytes, lymphocytes, and plasma cells from a perigastric node biopsy specimen (original magnification ×10).

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