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Pathologic quiz case: Fatal central nervous system lesions in an immunosuppressed patient

The patient was a 57-year-old white man with a 9-year history of chronic lymphocytic leukemia with subsequent progression to small cell lymphocytic lymphoma.

He was treated with multiple chemotherapeutic regimens without success and underwent allogeneic bone marrow transplant. During the 6 months following transplant, the patient was treated for graft versus host disease of the skin, gastrointestinal tract, and liver. Seven months posttransplant, he became febrile at home and blood was drawn for culture, which grew group A Streptococcus. A urine culture at that time was positive for Citrobacter freundii, Klebsiella pneumoniae, and group A Streptococcus. He was treated as an outpatient with ...

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