case_images: PMC10904597_01
case_images: Imaging and pathological examinations of the patient. (A) An abdominal CT examination showed that the appendix was swollen and thickened, accompanied by blurred fat space and a little exudation. (B) An abdominal color Doppler examination showed that the appendix was swollen and thickened. (C) The swollen appendix was removed, with a length of 10 centimeters and a body diameter of 0.6 centimeter. (D) Histopathological examination revealed a significant presence of inflammatory exudate and infiltration of inflammatory cells within the appendiceal cavity, accompanied by abundant blood clots and extensive Gram-negative bacilli colonization. The red arrow indicates the swollen appendix, and the black arrow indicates the distribution of Gram-negative bacilli.
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case_images: Therefore, computed tomography and color Doppler ultrasonography were performed, revealing thickening of the appendix without perforation or the obvious presence of a fecalith (Figures 1A, B). The appendix was observed to be swollen and purulent, and a subsequent pathological examination confirmed the diagnosis of acute suppurative appendicitis and suggested the possibility of Gram-negative bacilli infection (Figures 1C, D).
case_images: Colony characteristics of isolations from appendiceal purulent fluid. (A) Growth on Columbia blood agar after incubation at 35 C for 24 h. (B) Growth on MacConkey agar after incubation at 35 C for 24 h. (C) The Gram-stained morphology of P. citronellolis (2000X). (D) The Gram-stained morphology of E. coli (2000X). The white arrow indicates colonies of E. coli, and the black arrow indicates colonies of P. citronellolis.
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case_images: After 24 hours of culture, we observed the growth of two distinct types of Gram-negative bacterial colonies on both Columbia blood agar and MacConkey agar media (Figure 2). The total bacterial counts exceeded 1x10^6 CFU/mL (>=+++) using a semi-quantitative approach (Figures 2A, B).
case_images: A timeline with relevant data from the episode of care.
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