Confluent And Reticulated Papillomatosis Research Articles

Updated diagnosis criteria for confluent and reticulated papillomatosis: a case report.

Dear Editor: Confluent and reticulated papillomatosis (CRP), a rare skin disorder of unknown etiology, is characterized by hyperkeratotic papules confluent in the central area and reticulated hyperpigmented patch in the peripheral area1. Since Gougerot and Carteud first identified CRP in 1927, this disease has been diagnosed by using clinical courses, histological findings, and treatment results. However, other diseases, such as fungal infection or other pigmentary skin diseases, were frequently misdiagnosed as CRP because of the lack of diagnostic criteria for CRP. Therefore, Davis et al.1 proposed the diagnostic criteria for CRP on the basis of a study on 39 patients, as follows: (i) clinical findings of scaly brown macules and patches, with at least some appearing reticulated and papillomatous; (ii) involvement of the upper trunk and neck; (iii) negative fungal staining of scales; (iv) no response to antifungal treatment; and (v) excellent response to minocycline. However, a few cases of CRP sparing the upper trunk have also shown the typical histopathological findings, clinical findings, and treatment responses of CRP. A 42-year-old Korean woman presented to our clinic with a 4-year history of asymptomatic, brownish, and reticulated skin lesions in her antecubital and axillary regions (Fig. 1A). She reported that her skin lesions had worsened in May and improved slightly in October without any specific treatment. We performed a potassium hydroxide test to rule out fungal infection. Because the test result was negative at the antecubital fossa but positive at the axilla, we began treatment with oral itraconazole and topical flutrimazole cream for 2 weeks. Despite the 2 weeks of treatment, her skin lesions persisted. We then performed an axillary skin biopsy. Histopathological evaluation revealed papillomatosis and hyperkeratosis of the epidermis, and downward growth of the epidermis between the rete ridges (Fig. 2). Periodic acid Schiff staining did not reveal any fungal organism. On the basis of these findings, we diagnosed her condition as CRP limited to the flexural areas. After 2 months of doxycycline treatment (100 mg twice a day), her skin lesions completely disappeared (Fig. 1B). Fig. 1 (A) Hyperpigmented scaly macules with a reticular pattern on the axilla and antecubital fossa. (B) Complete resolution of the skin lesions after 2 months of doxycycline treatment. Fig. 2 Histopathological findings of the axillary lesion showing an orthokeratotic epidermis with acanthosis and papillomatosis plus mild perivascular lymphocytic infiltrate in the superficial dermis (H&E, ×200). Our patient exhibited only limited lesions at the antecubital fossae and axilla, which is inconsistent with the previous diagnostic criteria for CRP1. Several cases of CRP had involved various flexural areas alone, including the axilla2,3, popliteal fossa2, or antecubital regions4. These lesions fulfilled other diagnostic criteria for CRP. Therefore the criteria related to the primary affected sites should be revised. In addition, the criteria for fungal staining and response to antifungal treatment should be modified. Occasionally, CRP and fungal infection coexist5, as in this patient, however an important diagnostic consideration is that CRP lesions cannot be improved with antifungal treatment even in the presence of a positive fungal examination. Finally, minocycline3,4 has been known as the treatment of choice for CRP; however, other antibiotics have also been efficacious3. The exact reason for the effect of antibiotics is unclear, but many dermatologists speculate that their anti-inflammatory effect may be more predominant than their anti-bacterial effect1. As mentioned above, the previous diagnostic criteria for CRP had several limitations in cases of unusually involved location, co-infection with fungus, and use of antibiotics other than minocycline. Therefore, we propose a modified diagnostic criteria, as follows: (i) clinical findings includeing scaly brown macules and patches, with at least some appearing reticulated and papillomatous; (ii) involvement of the upper trunk, neck, or flexural areas; (iii) negative fungal staining of scales or no response to antifungal treatment; and (iv) excellent response to antibiotics.

Confluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Min Z, Tan C, Xu P, Zhu W. Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2014;31(5):335-337. doi:10.5114/pdia.2014.44011. APA Min, Z., Tan, C., Xu, P., & Zhu, W. (2014). Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 31(5), 335-337. https://doi.org/10.5114/pdia.2014.44011 Chicago Min, Zhong-Sheng, Cheng Tan, Ping Xu, and Wen-Yuan Zhu. 2014. "Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 31 (5): 335-337. doi:10.5114/pdia.2014.44011. Harvard Min, Z., Tan, C., Xu, P., and Zhu, W. (2014). Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 31(5), pp.335-337. https://doi.org/10.5114/pdia.2014.44011 MLA Min, Zhong-Sheng et al. "Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 31, no. 5, 2014, pp. 335-337. doi:10.5114/pdia.2014.44011. Vancouver Min Z, Tan C, Xu P, Zhu W. Letter to the EditorConfluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2014;31(5):335-337. doi:10.5114/pdia.2014.44011.

Efficacité des cyclines dans la papillomatose confluente et réticulée de Gougerot et Carteaud : deux cas

Background: Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud is an uncommon disorder of unknown cause for which a variety of treatments have been proposed.Objective: We attempted to evaluate the effectiveness of oral minocycline.Methods: Nine patients with CRP were treated with oral minocycline, 50 mg twice a day, for 6 weeks. The average follow-up period was 11 months. Recurrence rate, side effects, and effectiveness of therapy were assessed.Results: All patients except two had a 90% to 100% response to therapy. Recurrences were noted in three patients, all of whom responded to re-treatment with minocycline. None of the nine patients had an adverse reaction.Conclusion: Minocycline, 50 mg twice a day, is safe and effective for CRP.

融合性細網状乳頭腫症の兄妹例

症例 1：19 歳，男性。初診の 2 年前より体幹に褐色斑が出現した。腹部，背部，頚部に軽度のかゆみと鱗屑を伴う網状の褐色斑を認め，直接鏡検にて癜風菌陽性であったが，抗真菌剤内服・外用は無効であった。組織学的に表皮肥厚，乳頭腫症を認め融合性細網状乳頭腫症 (confluent and reticulated papillomatosis : CRP) と診断した。ミノサイクリン内服にて著明に改善し，内服を中止したところ，中止 1 ヵ月半後より皮疹が再発したため，再度ミノサイクリン内服後，軽快した。現在までに再発を計 4 回認めているが，ミノサイクリン内服で軽快している。症例 2：17 歳，女性。症例 1 の妹。初診の 1 年半前より体幹に褐色斑が出現した。腹部，背部に鱗屑を伴う網状の褐色斑を認め，直接鏡検にて真菌陰性。組織学的に表皮肥厚，乳頭腫症を認め CRP と診断した。ミノサイクリン内服を開始したが，めまい出現のためドキシサイクリンへ変更し，内服 4 週間後より症状の改善を認めた。その後，計 4 回の再発がみられたが，自然軽快しない場合はドキシサイクリン内服にて症状は軽快している。CRP はまれとされる疾患であり海外例を含め家族例の報告は少ない。

Confluent and Reticulated Papillomatosis Associated with 15q Tetrasomy Syndrome

© 2013 The Authors. doi: 10.2340/00015555-1437 Journal Compilation © 2013 Acta Dermato-Venereologica. ISSN 0001-5555 Chromosome 15q tetrasomy is in the heterogeneous group of extra-structurally abnormal chromosomes (1). The syndrome displays distinctive clinical findings represented by developmental delay, intellectual disability, epilepsy and autistic behaviour. Skin pigmentation has been observed in several cases (1). However, no previous reports have described the skin lesions in detail. We report here the first case of a patient with 15q partial tetrasomy syndrome who presented with skin pigmentation that was clinically and histologically consistent with confluent and reticulated papillomatosis (CRP).

Familial Confluent and Reticulated Papillomatosis: Two Brothers

Confluent and reticulated papillomatosis (CRP) is a rare disease presenting with keratotic pigmented papules located mostly on the chest, neck and trunk with unknown etiology. Genetic, keratinization abnormalities, abnormal host reaction to fungal or bacterial infections and endocrine diseases are suspected in the etiopathogenesis. The role of heredity in the pathogenesis of CRP arised with the familial case reports. There are sporadic case reports whereas familial reports are rare in the literature. Here, we present 22 and 20 year-old two brothers with familial confluent and reticulated papillomatosis. Our cases who live apart in different countries with different environments and climates, supply strong evidence for the genetic basis of the disease. This two brothers with CRP are presented due to rare familial occurence. (Turk J Dermatol 2012; 6: 108-10)

Tacrolimus in confluent and reticulated papillomatosis of Gougerot Carteaud

International Journal of DermatologyVolume 52, Issue 4 p. 513-514 Correspondence Tacrolimus in confluent and reticulated papillomatosis of Gougerot Carteaud Andrés Tirado-Sánchez MD, MSc, PhD, Andrés Tirado-Sánchez MD, MSc, PhD Servicio de Dermatología Hospital General de México Cuauhtemoc, D.F. México E-mail: andrestiradosanchez@hotmail.comSearch for more papers by this authorRosa M. Ponce-Olivera MD, MSc, Rosa M. Ponce-Olivera MD, MSc Servicio de Dermatología Hospital General de México Cuauhtemoc, D.F. México E-mail: andrestiradosanchez@hotmail.comSearch for more papers by this author Andrés Tirado-Sánchez MD, MSc, PhD, Andrés Tirado-Sánchez MD, MSc, PhD Servicio de Dermatología Hospital General de México Cuauhtemoc, D.F. México E-mail: andrestiradosanchez@hotmail.comSearch for more papers by this authorRosa M. Ponce-Olivera MD, MSc, Rosa M. Ponce-Olivera MD, MSc Servicio de Dermatología Hospital General de México Cuauhtemoc, D.F. México E-mail: andrestiradosanchez@hotmail.comSearch for more papers by this author First published: 18 April 2012 https://doi.org/10.1111/j.1365-4632.2011.04927.xCitations: 5 Conflicts of interest: None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume52, Issue4April 2013Pages 513-514 RelatedInformation

An Unusual Variant of Confluent and Reticulated Papillomatosis Masquerading as Tinea Versicolor

Confluent and reticulated papillomatosis (CARP), also known as Gougerot-Carteaud syndrome, is a rare disorder. It usually presents as hyperkeratotic brown papules that coalesce into plaques with a reticulated periphery on the central trunk of young adults. Confluent and reticulated papillomatosis is most often clinically confused with tinea versicolor and usually does not respond to therapy with antifungals. Minocycline is the treatment of choice. Four cases of CARP with the unusual presentation of hypopigmented lesions masquerading as tinea versicolor in dark-skinned (Fitzpatrick skin types IV-V) patients are presented. All cases exhibited characteristic features of CARP on biopsy results and responded to minocycline of several months' duration. Two of the cases were also treated with adjuvant topical tazarotene. The hypopigmented variant of CARP in dark-skinned patients makes the clinical differentiation from tinea versicolor extremely challenging. Physicians encountering darkly pigmented individuals with hypopigmented plaques unresponsive to antifungals should have a high clinical suspicion for the hypopigmented variant of CARP.

Confluent and reticulated papillomatosis: clinical and histopathological study of 10 cases from Lebanon

Confluent and reticulate papillomatosis (CRP) is a rare disorder that has mostly been described in case reports and limited case series. Studies on this condition from our region are lacking. To describe the clinical and histopathological findings, as well as response to treatment of all patients diagnosed with CRP at the American University of Beirut Medical Center (AUB-MC) between 1999 and 2009, and to compare our findings with those published in the literature. Confluent and reticulate papillomatosis was diagnosed in 10 patients (five men, five women). Mean age at diagnosis was 19 years. Duration of lesions ranged from few months to several years. Skin lesions mainly consisted of reticulated, pigmented macules, patches and plaques. The most common area of involvement was the chest in five cases. The rash was asymptomatic in eight patients. Skin biopsy specimens from all patients revealed hyperkeratosis, papillomatosis and variable acanthosis. Whereas follicular plugging was observed in nine cases, anastomosis of the rete ridges was noted in three. Periodic acid Schiff stains highlighted yeast forms in six cases. The clinical and histopathological features of the CRP patients in our study are generally comparable to those published in the literature, with minor differences. Clinically, one case had an atypical clinical presentation, and microscopically follicular plugging was seen in the majority of cases. Yeast-like spores were seen in six cases further supporting a role of Malassezia furfur in the pathogenesis of CRP.

Confluent and reticulated papillomatosis on the arm successfully treated with minocycline

Confluent and reticulated papillomatosis on the arm successfully treated with minocycline

Papillomatose confluente et réticulée de Gougerot et Carteaud faciale ou hyperkeratotic head and neck Malassezia dermatosis ?

We report three patients with brown hyperkeratotic lesions of the face. Two cases have been published [Boralevi et al. (2006)] under the title "Hyperkeratotic Head and Neck Malassezia Dermatosis (HHNMD)". A patient recently diagnosed with confluent and reticulated papillomatosis (CRP) (Gougerot-Carteaud) allowed us to link theses two entities. A 56-year-old woman was followed for extensive CRP. Cultures for fungi and bacteria were negative. During the course of the disease, she developed brown hyperkeratotic dermatitis on both cheeks. CRP is a rare or probably under-diagnosed condition. Brown, scaly, hyperkeratotic macules and patches are observed with a confluent and reticulated disposition. The chest and neck are generally involved, but extensive forms are possible. Facial involvement is rare. HHNMD, the disorder we earlier described, could be a facial presentation of CRP with contingent yeast colonisation. A therapeutic test with tetracyclines may be considered in HHNMD.

Confluent and reticulated papillomatosis associated with polycystic ovary syndrome treated with a combined contraceptive containing drospirenone

This letter to the editor discusses a case involving a young woman diagnosed with confluent and reticulated papillomatosis (CRP). It suggests that drosperinone may be a good therapeutic option in the treatment of women with CRP.

Two cases of confluent and reticulated papillomatosis successfully treated with Chinese drug jianpizhiyang granula

Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and Carteaud. It is characterized by papules that become confluent in the center and reticulated at the periphery. The etiology and pathogenesis of CRP are not precisely known and there is no standard therapy for it. In the recent cases reported, treatment of choice is minocycline. In this report, we present two cases of CRP responding well to Chinese drug, Jianpizhiyang. Some elements in Jianpizhiyang granula were thought to have anti-inflammatory. We expect that, which always has little side-effect, will be a good choice for CRP.

Two Cases of Confluent and Reticulated Papillomatosis with an Unusual Location

Sir, Confluent and reticulated papillomatosis (CRP) is a rare dermatosis of unknown origin characterized by hyperpigmented, confluent papules. The sites of predilection are the neck, inter-mammary area and abdomen (1). Rarely, CRP develops at the other sites, such as the knee, elbow, hand, and antecubital and popliteal fossae (2, 3). We describe two rare cases of CRP that developed at the elbow and popliteal fossae.

Three Cases of Concomitant Acanthosis Nigricans with Confluent and Reticulated Papillomatosis in Obese Patients

Acanthosis nigricans (AN) is characterized by symmetric, velvety, gray-brown hypertrophied plaques most commonly on the axillae and neck. Confluent and reticulated papillomatosis (CRP) is manifested by papules in the mid-chest that coalesce in the midline, and are arranged in a reticulated pattern peripherally. Both diseases are known to be related to endocrinopathies such as diabetes mellitus (DM), an insulin resistant state and obesity with unknown mechanisms. Herein, we presented three cases of concomitant acanthosis nigricans with confluent and reticulated papillomatosis in obese patients.

Confluent and reticulated papillomatosis successfully treated with amoxicillin

Conflicts of interest: none declared. Sir, Further to the recently published experience of the Mayo Clinic in the treatment of confluent and reticulated papillomatosis (CRP),1 we report a case of CRP treated successfully with amoxicillin. Confluent and reticulated papillomatosis is an unusual skin disorder originally described by Gougerot and Carteaud. It consists of a scaly, macular and papular eruption typically affecting the seborrhoeic areas of young adults. As the name suggests, lesions become confluent in the centre, coalescing to form a reticulated pattern at the periphery of affected areas. We describe a 29‐year‐old female who initially presented in 2004 with a 4‐year history of an asymptomatic eruption affecting the axillae, mons pubis, submammary (Fig. 1) and inguinal folds. She had been treated unsuccessfully with topical steroids and antifungal agents. Differential diagnoses included a fungal eruption, pityriasis versicolor, Darier's disease and Dowling–Degos disease (reticulate pigmented anomaly of the flexures) but these were excluded by investigations; skin scrapings for mycology were negative and a skin biopsy showed mild chronic inflammation in the upper dermis with some mild pigmentary incontinence. Wood's light examination was unremarkable. A skin swab and culture of skin scrapings on chocolate agar were negative. Following clinical and histological correlation a diagnosis of CRP was made.

A case of maxacalcitol‐resistant confluent and reticulated papillomatosis successfully treated with minocycline

The Journal of DermatologyVolume 33, Issue 3 p. 223-224 A case of maxacalcitol-resistant confluent and reticulated papillomatosis successfully treated with minocycline Yosuke YAMAMOTO, Yosuke YAMAMOTO Department of Dermatology, Toyooka Hospital, Hyogo,Search for more papers by this authorMasafumi KADOTA, Masafumi KADOTA Department of Dermatology, Toyooka Hospital, Hyogo,Search for more papers by this authorYouichi NISHIMURA, Youichi NISHIMURA Department of Dermatology, Fukui Red Cross Hospital, Fukui, JapanSearch for more papers by this author Yosuke YAMAMOTO, Yosuke YAMAMOTO Department of Dermatology, Toyooka Hospital, Hyogo,Search for more papers by this authorMasafumi KADOTA, Masafumi KADOTA Department of Dermatology, Toyooka Hospital, Hyogo,Search for more papers by this authorYouichi NISHIMURA, Youichi NISHIMURA Department of Dermatology, Fukui Red Cross Hospital, Fukui, JapanSearch for more papers by this author First published: 24 March 2006 https://doi.org/10.1111/j.1346-8138.2006.00051.xCitations: 1 Yosuke Yamamoto, M.D., 43-2-503 San’no-cho, Shogoin, Sakyo-ku, Kyoto 606-8392, Japan Email: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue3March 2006Pages 223-224 RelatedInformation

Confluent and Reticulated Papillomatosis

Confluent and reticulated papillomatosis (CARP) was first described >60 years ago. It is distinct from acanthosis nigricans. This article presents the results of a review of the literature in MEDLINE through May 2006 using the terms 'confluent and reticulated papillomatosis', 'reticulated and confluent papillomatosis of Gougerot and Carteaud', and 'reticulated papillomatosis'. A recent report has linked the presence of Dietzia spp. (family: Dietziaceae; suborder: Corynebacterineae; order: Actinomycetales) in the skin to CARP. CARP has also been linked to defects in keratinization. Other possible causes of CARP that have been suggested but seem less likely include endocrine abnormalities, Pityrosporum, a reaction to UV light, and a variation of cutaneous amyloidosis. CARP has been reported worldwide and occurs in both sexes, all age groups, and all races. The disorder can initially manifest as hyperkeratotic or verrucous papules that coalesce to form a reticular pattern peripherally and confluent plaques centrally. Although a variety of treatments for CARP exist, oral minocycline 50-100mg twice daily has been the preferred treatment. However, recent reports of the effectiveness of azithromycin 250-500mg three times weekly may make azithromycin the preferred treatment for CARP, since it has a more benign adverse effect profile than minocycline. Other effective antibacterial treatments include fusidic acid 1000mg daily, clarithromycin 500mg daily, erythromycin 1000mg daily, tetracycline 500mg twice daily, and cefdinir 300mg twice daily. If a recent finding that CARP is caused by a bacterial microorganism is replicated, treatment should likely be determined by bacterial sensitivities, antibacterial adverse effect profiles, and cost considerations. Other oral treatments of CARP that are effective but currently disfavored because of the effectiveness of minocycline include isotretinoin, acitretin, and etretinate. There have been mixed reports regarding the effectiveness of topical treatments, which include selenium sulfide, ketoconazole cream, tretinoin, tazarotene, tacalcitol, and calcipotriene (calcipotriol).

Confluent and reticulate papillomatosis (Gougerot-Carteaud syndrome): a minocycline-responsive dermatosis without evidence for yeast in pathogenesis. A study of 39 patients and a proposal of diagnostic criteria

Confluent and reticulate papillomatosis (CRP) (Gougerot-Carteaud syndrome) is a disorder that has been characterized in only small cohorts of patients. Better to characterize the clinical and pathological findings of the disorder. We retrospectively reviewed the clinical presentation, response to treatment and histological findings of patients presenting to Mayo Clinic (Rochester, MN, U.S.A.) with CRP. The disorder was diagnosed in 39 patients between 1972 and 2003. Mean age at onset of the skin eruption was 15 years (range 8-32); 21 patients (54%) were male; most were white; most (33) presented for reasons of cosmesis; and eight described the rash as mildly pruritic. At presentation, the skin eruption had been present for a mean of 3.1 years (range 3 months-20 years) and had been recalcitrant to treatment, including antifungal treatment. Typical objective findings were scaling brown macules and patches and velvety papules and plaques, reticulated and papillomatous at least in part, involving the upper trunk, axillae and neck. The most frequent initial diagnostic impressions were tinea versicolor, acanthosis nigricans and CRP. Scales in 32 cases were examined with potassium hydroxide: eight (25%) showed hyphae, and 24 (75%) did not. Skin biopsy specimens from 21 patients showed variable degrees of hyperkeratosis, acanthosis and papillomatosis. Minocycline was prescribed for 22 patients, of whom 14 of 18 (78%) had complete clearing of the skin eruption and four (22%) a partial response. The skin eruptions recurred after stopping treatment in six patients. CRP occurs predominantly in young adults and teenagers, with cosmetically displeasing brown scaling patches and plaques affecting the neck, upper trunk and axillae. Frequently, the diagnosis is delayed and the disorder not recognized by physicians, including dermatologists. Clinically, the eruption is most often confused with tinea versicolor. Potassium hydroxide staining of the scale is negative in the majority of cases, implying that fungi are not involved in the pathogenesis of this condition, as has been previously proposed. It is important to recognize this disorder, because minocycline therapy is highly effective in most patients. Criteria for the diagnosis are proposed.

Dietzia strain X: a newly described Actinomycete isolated from confluent and reticulated papillomatosis

Confluent and reticulated papillomatosis (CRP) is a rare skin disorder. To date its aetiology remains uncertain. The possibility of an infectious aetiology has been supported by case reports of therapeutic response to antibiotic therapy. We have isolated and identified a previously unknown Dietzia strain, an Actinomycete, from skin scrapings of a 17-year-old boy with CRP. We propose that this organism may be the aetiological agent of CRP. Further investigations are necessary to determine the potential role of this Actinomycete in the pathogenesis of CRP.