Case Study: Spleen SpecimenA 23-year-old man had complained of right lower quadrant abdominal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest. The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea. The onset of fever and vomiting pr

A 23-year-old man had complained of right lower quadrant abdominal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest. The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea. The onset of fever and vomiting promted a visit to the emergency room. His temperature was 101° F, pulse was 90/minute, and palpation of the right lower abdomen elicited severe pain.

The white blood count was 23,000/mm with a distinct left shift, including 5% metamyelocytes. Emergency surgery was performed for a large peri-appendiceal abscess. During surgery, multiple abscesses were noted in the spleen, which was removed. Recovery was uneventful following five days of adjuvant clindamycin therapy.

Illustrated in the top image are tiny pinpoint 24-hour colonies recovered from one of the splenic abscesses. The wide zones of beta hemolysis are better seen in the close-in view of the 36 hour culture shown in the lower image. Streptococcus anginosus ("milleri" ) can be suspected if which one of the following odors is detected?