European Journal of Pediatrics

, Volume 171, Issue 3, pp 593–593 | Cite as

Black tongue associated with Kocuria (Micrococcus) kristinae bacteremia in a 4-month-old infant

  • Eda Karadag Oncel
  • Meryem Seda Boyraz
  • Ates Kara
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Diarrhea Vancomycin Blood Culture Ceftriaxone Central Venous Catheter 
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A 4-month-old female infant was admitted to the hospital with a history of prolonged diarrhea and severe failure to thrive. The patient's diarrhea started when she was 2 months old which prompted hospitalization a month later for further investigation. Discontinuation of enteral feeding resulted in resolution of her diarrhea, and total parenteral nutrition was continued via a central venous catheter (CVC).

After 10 days, she developed fever. Physical examination was unremarkable except for a black discoloration of the tongue (Fig. 1). Empirical antibiotic treatment was provided with ceftriaxone. However, early report of a gram-positive growth in blood cultures at 48 h prompted addition of vancomycin to the treatment regimen. This growth was later identified as Kocuria (Micrococcus) kristinae, which was detected in two separate aerobic blood cultures. The patient showed a dramatic response to vancomycin treatment, and blood cultures obtained 48 h later from the indwelling CVC and from a peripheral vein were negative. The black discoloration of the tongue completely resolved a week after initiation of vancomycin treatment (Fig. 2), and combination antibiotic therapy was discontinued after a total of 14 days. To the best of our knowledge, this is the first reported case in the English literature of K. kristinae bacteremia as a cause of black hairy tongue.
Fig. 1

Black discoloration of the dorsal tongue

Fig. 2

Discoloration resolution after treatment

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Eda Karadag Oncel
    • 1
    • 2
  • Meryem Seda Boyraz
    • 1
  • Ates Kara
    • 1
  1. 1.Department of Pediatrics, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  2. 2.Pediatric Infectious Disease UnitHacettepe University Child HospitalAnkaraTurkey

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