Case Report Neisseria lactamica Causing a Lung Cavity and Skin Rash in a Renal Transplant Patient: First Report from India Khalid Hamid Changal, 1 Adnan Raina, 1 and Sheikh Shoaib Altaf 2 1 Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar 190011, India 2 Internal Medicine, Mercy Catholic Medical Center, Philadelphia, PA 19026, USA Correspondence should be addressed to Khalid Hamid Changal; khalidchangal@gmail.com Received 5 January 2016; Accepted 14 February 2016 Academic Editor: Pere Domingo Copyright © 2016 Khalid Hamid Changal et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Neisseria lactamica, a commensal, has been very rarely reported to cause diseases in immunocompromised hosts. In medical literature, there is only one report of a cavitatory lung lesion caused by it. Te patient was a kidney transplant recipient. Neisseria lactamica was found to be the cause of his pulmonary cavity and a desquamating rash on feet. With the rapidly spreading medical advance, more and more patients are getting organ transplants, so the population of immunocompromised people is on the rise. We expect more sinister and less expected organisms to cause diseases in patients who have organ transplants. 1. Introduction Neisseria lactamica is a normal commensal of the upper respiratory tract in humans. In immunocompromised hosts this organism may become pathogenic and cause diseases. Tere have been only a few reports of this organism causing a disease, mostly in immunocompromised hosts. 2. Case Te patient was a 55-year-old male who had undergone live related kidney transplantation 8 months prior. For induction the patient had received antithymocyte globulin (equine) at 15 mg/kg for 5 days. He was on maintenance immunosuppres- sive therapy with tacrolimus, mycophenolic acid mofetil, and prednisone. He presented with gradually worsening cough, expectoration, and fever for a couple of weeks. On examina- tion he had crepitations in lef lower lung felds posteriorly. Of particular note was poor orodental hygiene with multiple carious teeth. Chest roentgenogram showed infltrates in lef lower zone (Figure 1(a)). Other laboratory investigations were normal except for a mild neutrophilic leukocytosis. A CECT chest was done and a thick walled cavity was seen in the lower lobe of lef lung posteriorly (Figure 2). While these evaluations were done patient continued to have fever and developed a desquamative rash on feet (Figure 3). A skin biopsy taken showed nonspecifc infammatory response and some epidermal necrosis; however, there was no evidence of any drug reaction or staphylococcal infection. Te material obtained from skin biopsy did not grow any organism on cul- ture. A blood culture was taken and patient was empirically given cefriaxone injections. A CT guided transthoracic lung biopsy was done which showed nonspecifc infammatory response and no microorganism was seen on Gram and acid fast staining. Tere was no clinical or laboratory evidence of tuberculosis, fungal infections, malignancy, or vasculitis. Also there was no evidence of viral infections like HIV, CMV, or hepatitis virus infections. Blood culture and the material obtained from the lung biopsy material both grew a Neisseria species. Te isolate was oxidase and catalase positive but superoxol negative. Genetic testing showed 99% homology with both N. lactamica and Neisseria polysaccha- rea. Te Neisseria species isolated was o-nitrophenyl--D- galactopyranoside positive and generated acid from sucrose. Tis helped in excluding N. polysaccharea. Te organism was thus identifed both echocardiogram showed no endocarditis. Te kidney functions were normal and there was no evi- dence echocardiogram showed no endocarditis. Te kidney functions were normal and there was no evidence of graf rejection. Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2016, Article ID 1932963, 3 pages http://dx.doi.org/10.1155/2016/1932963