! "#$#% &’# ()*+ "+)(, -. +, *+// "/. 0++1 2 + **)"*(1(1 +,)/1 +1(1 "+( (1 +, (0(3 2 /1(+1)( -4+11+"4+..+ ,+ 5 + +2+6 +, +3+/ abcd Departments of Microbiology and Pulmonary Medicine, AIIMS, Patna, Bihar, India +-1+"1 7!! #!#8 9 "0 #: 5#’ $#8 $’#% ;’ ’ ! &% $ #! :# <7 %9 ##5!!& ;’ "0 <7 $#9 ;’ 95! = "0 #: 5 7 &! $#$ :# # :#!!#; 58 &$5!8 % ’8 5 :>&!8 :#8 # 78 5# +!# 5# &$5!8 5 :: "0 ;’’ 7? 7$! 7 7# ::&! +!! ’ $# % #: ’ @(.3,: , SCV , Susceptibility is an established respiratory pathogen, with multidrug resistance seen very commonly(Gupta N , 2011). is also a proven respiratory pathogen, with most number of cases in Cystic fibrosis, and is also associated with worse lung function in Cystic fibrosis(Goss and Muhlebach, 2011). Chronic obstructive pulmonary disease (COPD) is also a risk factor for pneumonia due to ,which can also infect children, while Diabetic ketoacidosis is also a risk factor for lung infection by (http://downloads.lww.com, Verduin , 2002). is also common in nosocomial pneumonia(Verduin , 2002). SCV can be difficult to diagnose since pigmentation is often absent, hemolysis is absent and coagulase may be delayed (Vaudaux P , 2006). Mixed pneumonia can be found with in conjunction with and , but it is rare in conjunction with SCV (Enright MC , 1997). We here discuss such a case. "+( (1 JA, a 35 year7old male patient, who was non7smoker presented to the Pulmonary Medicine OPD with chief complaints of slowly progressive cough which used to occur more in early morning with mucoid expectoration and respiratory distress since the last 2 months. The patient also had low grade fever without evening rise of temperature. There was no history of hemoptysis. The patient gave history of travel to the middle east 5 months back. Chest X ray (PA view) showed no abnormality. On haematological investigation, his Total leucocyte was 12,400 /mm3 , polymorph 82%, Lymphocyte 14%, Random blood sugar 110 mg%, and blood urea nitrogen within normal limits. Sputum sample was obtained and sent for microbiological evaluation. Gram stain showed copious pus cells, Gram negative coccobacilli mostly in pairs, and gram positive cocci of different sizes arranged in clusters. ZN staining for AFB was negative in two consecutives sample .Culture of the sample was carried out in 5% sheep blood agar and MacConkey agar. After overnight incubation at 37⁰C, 2 types of colonies were found: opaque, small (0.1 mm) low convex colonies that were pink on MacConkey agar, and larger (2 mm), translucent colonies that were non7lactose fermenting on MacConkey agar. The smaller colonies showed Gram positive cocci on Gram’s staining, while larger colonies revealed Gram negative coccobacilli arranged in pairs. The larger colonies were also oxidase positive and reduced nitrate to nitrite, but were negative for indole production, citrate utilisation and sugar fermentation on TSI slant. The smaller colonies were non7pigmented and delayed positive for slide coagulase test. Both colonies were non7hemolytic. Smaller colonies turned to larger, wild7type colonies on growing in a Carbon dioxide7rich environment, in a CO 2 incubator (having 5% CO 2 ). Thus the smaller colonies turned out to be CO 2 auxotrophic SCV . There was no increase in size on growing in chocolate agar (to check for hemin auxotrophism) or around Vitamin K disks (15 µg Vit. K) on a Mueller Hinton Agar plate. Antibiotic susceptibility of both isolates were done by Kirby Bauer disk diffusion on Mueller Hinton Agar, using the following disks: Cefotaxime (30 µg), Amoxiclav (25 µg), Amikacin (30 µg), Netilmicin (30 µg) only in case of SCV , Piperacillin7