Image 17: This聽 male in his 60s, from the Caribbean, was admitted with a nasopharyngeal cancer, with metastases to the spine for which he received corticosteroids and morphine. During a month long admission he developed significant unexplained anemia and severe constipation with intermittent ileus, thought due to his pain medication and spinal lesions. He then developed a cough with purulent sputum and confusion. A sputum culture plate had the appearance seen here. The diagnosis was
