case_images: PMC11835467_01
case_images: Chest CT of the patient. Chest CT shows (a) aspirated sputum in the main bronchus (red arrow) and (b) mild lung infiltration (red arrow) with underlying lung damage caused by COPD.. COPD, chronic obstructive pulmonary disease
case_images: cureus-0017-00000077676-i01.jpg
case_images: PMC11835467_01_cureus-0017-00000077676-i01.jpg
case_images: FIG1
case_images: Gram-stained sputum and blood smears showing the appearance of Sarcina ventriculi on microscopy. (a) Sputum smear showing large Gram-positive cocci in clusters of tetrads (black arrows; magnification x1,000). (b) Gram-stained blood smear sample obtained from a positive anaerobic blood culture bottle after 47 hours of culture showing large Gram-positive clusters of tetrads (magnification x1,000). Due to the large size of the Gram-positive clusters of tetrads, clear focus could not be achieved. The samples were collected immediately prior to initiating antibiotic treatment.
case_images: cureus-0017-00000077676-i02.jpg
case_images: PMC11835467_01_cureus-0017-00000077676-i02.jpg
case_images: FIG2
case_images: Large Gram-positive cocci clustered in tetrads were present in the sputum (Figure 2a), clearly distinguishable from staphylococci. Gram staining of the blood culture revealed large Gram-positive cocci in clusters of tetrads with difficulty in obtaining a clear focus on microscopy owing to their large size (Figure 2b), morphologically similar to the Gram-positive bacteria that had been seen in the sputum (Figure 2a).
case_images: Appearance of Sarcina ventriculi colonies on Brucella HK agar and bacterial morphology on Gram staining. (a) Characteristic irregular-shaped, grayish colonies with ragged edges of S. ventriculi growing on Brucella HK agar. The colonies were cultured from a blood culture sample plated on Brucella HK agar and incubated at 35 C for 48 hours under anaerobic conditions. (b) Microscopic image of Gram-stained S. ventriculi grown on Brucella HK agar (magnification x1,000).
case_images: cureus-0017-00000077676-i03.jpg
case_images: PMC11835467_01_cureus-0017-00000077676-i03.jpg
case_images: FIG3