Case Study: March 2010

History

A 50 year old female presents with epiphora. A mass is found in the lacrimal sac. At surgery, a dacryolith is removed and sent for histology.

The dacryolith contains gram positive, silver positive, acid fast, beaded, branching organisms. See figure (silver stain).

Questions

1. What is the differential diagnosis for this infectious agent?
2. What is the actual diagnosis