Pulmonary pseudolymphoma presenting as a solitary nodular density with an air bronchogram.

PULMONARY PSEUDOLYMPHOMA 691 percutaneous or bronchoscopic aspiration, avoiding contammation by bacteria in the upper airway. Enterococci have been implicated primarily in the genitourinary, endocardial, and abdominal infections. Few reports have considered them as a cause of a bacterial pneumonia or lung abscess. Rantz and Kirby,3 in a review of streptococcal infections, reported none. Duma et a1 reviewing 154 streptococcal blood isolates at the Massachusetts General Hospital found that 29 percent could be classified as group D.4 Only one case involved the lower respiratory tract, producing necrotizing pneumonia. Enterococci are members of group D streptococci and consist of Streptococcus fecalts and Streptococcus faecium. They can grow in the presence of 6.5 percent NaC1, at a pH of 9.6, at 10#{176} C, and 45#{176} C, and withstand heating at 60#{176} C for 30 minutes. In the two cases reported, combination antimicrobic therapy of penicillin G or ampicihin with an aminoglycoside agent was used. This combination was selected because of the severity of the infection and the reported synergism of penicillin and aminoglycoside drugs.48 The mechanism is believed to be increased susceptibility of the enterococcus to the bactericidal effects of streptomycin or gentamicin following damage to the bacterial cell wall by the penicillin.8 The use of 2 gm of streptomycin daily for 23 dayS produced persistent impairment of equilibrium in the first patient. In view of the reported value of gentamicin in combination with penicillin in the treatment of enterococcal infections and a lesser degree of vestibular toxicity, it was selected for the second patient. Duma et al found that a significant number of enterococci required optimal, but unpredictable concentrations of penicillin and streptomycin, and determination of in vitro synergism was essential for each strain. Watanakunakorn found that all enterococci were not killed by the synergistic action of penicillin G and aminoglycoside antimicrobics and that he could not prediet effectiveness of therapy without actual in vitro testing.