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PubMed1997

Actinomycosis of the thyroid gland masquerading as a neoplasm.

Actinomycetal infections involving the head and neck often pose a diagnostic puzzle to the otolaryngologist. A rare case of unilateral thyroid swelling due to actinomycosis is described. Although the clinical, laboratory and imaging studies strongly suggested a thyroid neoplasm, the histological examination revealed the presence of Actinomyces sp. in the excised lesion. The manifestations of actinomycosis of the head and neck, its pathogenesis and the difficulties encountered in the diagnosis and treatment of the disease are hereby reviewed.

Actinomycosis↗
PubMed1997

Actinomycosis of the posterior triangle: a case report and review of the literature.

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at the apex of the posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic 'sulphur granules' in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobic culture of pus and biopsy specimens should be performed in addition in Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

Actinomycosis, Cervicofacial↗
PubMed1998

Actinomycosis of the middle ear.

Another case of actinomycosis of the ear is described in a nine-year-old boy, drawing attention to the increasing incidence of diseases of the ear considered to be rare. The patient presented with the clinical signs of chronic purulent otitis media, not responding to conservative treatment. After the diagnosis of actinomycosis was established the patient was treated by surgery and long-term antibiotic medication, responding favourably.

Actinomycosis↗
PubMed2006

Actinomycosis of the tongue: a diagnostic dilemma.

Actinomycotic infections of the cervicofacial region are not uncommon. However, actinomycosis of the tongue is rare. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. We report a patient who presented with a tumour-like tongue mass causing speech disturbance, diagnosed as actinomycosis.

Actinomyces↗
PubMed2003

Esophageal actinomycosis after allogeneic peripheral blood stem cell transplantation for extranodal natural killer/T cell lymphoma, nasal type.

We report a 19-year-old man with extranodal natural killer (NK)/T cell lymphoma, nasal type treated by allogeneic peripheral blood stem cell transplantation (allo-PBSCT). His lymphoma was chemoresistant, and disseminated during local radiotherapy. The patient received allo-PBSCT from his HLA-1 locus mismatched sister using busulfan (BU), cyclophosphamide (CY) and VP-16 as the conditioning regimen. His course was complicated by esophageal actinomycosis 9 months after transplantation, which resulted in the rupture of the right common carotid artery. These observations suggest that actinomycosis should be monitored carefully after transplantation in patients who have received local radiation therapy before the procedure.

Actinomycosis↗
PubMed2000

Endobronchial actinomycosis associated with a foreign body.

Primary endobronchial actinomycosis is an exceedingly rare condition which closely mimics bronchial carcinoma both clinically and radiologically. We report the case of a middle-aged Chinese man who had right lower lobe endobronchial actinomycosis associated with inhalation of a presumed chicken bone. The patient made a complete clinical and radiological recovery after a 2 month combined course of amoxycillin and clavulanate, after removal of the foreign body, which was only detected after using contiguous computed tomography. Our experience in the management of this patient should help clinicians in the investigation and management of this rare but treatable condition.

Actinomycosis↗
PubMed2001

Disseminated actinomycosis presenting as a renal tumor with metastases.

Disseminated actinomycosis is uncommon in the pediatric population and rarely presents as a renal mass mimicking a renal tumor with metastases. Diagnosis may be difficult. In this case, percutaneous biopsy results only showed necrosis and fibrosis and, hence, were not helpful in diagnosis. Exploratory laparotomy and open biopsy results showed that this renal tumor was an actinomycotic abscess with similar abscesses in the liver and lung masquerading as metastases. The treatment for disseminated actinomycosis is with parenteral and oral penicillin.

Abscess↗
PubMed2002

[Sonographically guided fine-needle aspiration of abscesses in cases of abdominal actinomycosis].

This report describes two cases of isolated abdominal actinomycosis. a) A 52-year-old man developed a peripancreatic abscess in the course of two years after laparoscopic cholecystectomy and repeated laparotomy because of postoperative peritonitis. b) A 19-year-old man, who had a perityphlitic abscess following appendectomy performed because of appendicitis. The definitive diagnosis of abdominal actinomycosis was confirmed by percutaneous ultrasound-guided fine-needle aspiration: In both cases culture of the aspirated material yielded Actinomyces (A.) israelii. As concomitant microflora we found Klebsiella and Actinobacter species in the first case and Haemophilus (Actinobacillus) actinomycetem comitans in the other case. "Sulfur granules" obtained from the pus showed histological aggregates of Actinomyces in both cases. After surgical treatment and antibiotic therapy, both patients recovered completely.

Abdominal Abscess↗
PubMed1988

Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism.

Actinomycosis is an uncommon infection. The regions mostly involved are the cervico fascial area, the thorax and the abdomen. The thoracic variety accounts for approximately 15% of the cases. Clinical pictures of pulmonary neoplasm, abscess, and empyema have been described. Misleading symptoms often delay the right diagnosis. The present study describes a case of actinomycosis with pleuro-pulmonary involvement. A 48-year woman had been well until two and a half years previously, when she developed symptoms suggestive of pneumonia. When referred to a medical clinic with thoracic pain and tiredness, pulmonary embolism was suspected. Inhalation and perfusion scintigraphy showed several perfusion defects. There were several relapses, with clinical pictures suggestive of pulmonary embolism, before an abscess in the left axilla appeared. Drained pus showed no growth of Actinomycetes. Correct diagnosis of the true cause was only possible by direct microscopy. Possible symptoms and the diagnostic difficulties when Actinomycetes is involved are discussed.

Actinomycosis↗
PubMed1999

[Abdominal actinomycosis after stomach surgery in a patient with long-term rheumatoid arthritis treated with methotrexate].

HISTORY AND ADMISSION FINDINGS: A 78-year-old woman had a 30-year history of rheumatoid arthritis, of late treated with prednisolone and methotrexate. A week before admission she had first noticed a mass about 3 cm in diameter, at the lower end of a scar from a Billroth II gastric resection for gastric ulcer, performed 4 months before. She reported to have lost 6.5 kg in weight. On admission a moderately mobile, hard mass was palpated on the abdomen. INVESTIGATIONS: Ultrasound and computed tomography revealed a superficial, inhomogenous space-occupying lesion with poorly circumscribed margins. TREATMENT AND COURSE: After two days the skin over the mass became reddened and a laparotomy was performed because an incarcerated herniation was suspected. An abscess and inflammatory adhesions were found in the area of the transverse colon, histologically shown to be a chronic purulent abscess with granular clusters of pathogens indicating actinomycosis. After 3 weeks' treatment with imipenem i.v. the patient became free of symptoms, oral doxycyclin was continued for a further 6 months. CONCLUSION: Actinomycosis should be considered in the differential diagnosis of a tumour of undetermined benignity in the region of the head, chest or abdomen in immunosuppressed patients. This bacterial infection should be thought of especially if the gastrointestinal mucosa has been penetrated by invasive procedures.

Abdominal Abscess↗
PubMed1993

[Abdominal actinomycosis].

Twelve years after adnexectomy, performed for actinomycosis of the left ovary, a 32-year-old woman developed abdominal and back pain. A solid tumour was palpated in the left lower abdomen. Colon contrast examination revealed a subtotal stenosis in the sigmoid colon, while sonography showed a complete stenosis of the left ureter with left hydronephrosis. Relaparotomy demonstrated a stone-hard tumour at the rectosigmoid junction, which involved the right ovary and ureter, as well as having infiltrated the retroperitoneum, predominantly on the left. After resection of the sigmoid colon, uterus and right ovary, as well as of the ureteric stenosis with reanastomosis, the further course was without complication. Histological examination confirmed actinomycosis of the left ovary, sigmoid colon and pelvic mesocolon. Therapy with amoxycillin, 500 mg three times daily, was started. As the patient had worn an intrauterine pessary for several years, primary infection of the uterus with spread into the abdominal cavity via tube and ovaries is likely to have been the course of events. The recurrence was probably caused by reactivation of residual actinomycetes in the retroperitoneum and pelvic mesocolon.

Abdomen↗
PubMed1993

[Thoracic actinomycosis masquerading as a central bronchial carcinoma].

A 41-year-old cachectic woman (weight 42.7 kg, height 1.65 m) was admitted to hospital because a chest radiogram had suggested a left central bronchial carcinoma. Four days previously she had noted for the first time a firm elastic swelling parasternally in the fourth intercostal space. This swelling was directly aspirated by needle after bronchoscopic results had been nonspecific. Surprisingly, pus containing actinomyces filaments was aspirated. Computed tomography confirmed a paramediastinal abscess, 8 x 5 x 6 cm, which had infiltrated into the left thoracic wall. The abscess was incised and drained. After treatment for two weeks, initially with three times daily 10 mega penicillin G intravenously, followed by erythromycin, 500 mg twice daily for 12 weeks, the thoracic actinomycosis was no longer demonstrable radiologically and by ultrasound. It is suggested that in any unclear pulmonary infiltrate without evidence of tuberculosis or carcinoma actinomycosis should be included in the differential diagnosis.

Actinomycosis↗
PubMed2003

Actinomyces hongkongensis sp. nov. a novel Actinomyces species isolated from a patient with pelvic actinomycosis.

A bacterium was isolated from the pus of a patient with pelvic actinomycosis. The cells were strictly anaerobic, straight, non-sporulating, Gram-positive rods. It grows on sheep blood agar as non-haemolytic, pinpoint colonies after 24 hours of incubation at 37 degrees C in anaerobic environment. It is non-motile and does not produce catalase. 16S ribosomal RNA (rRNA) gene sequencing showed that there were 6.6% difference between the 16S rRNA gene sequence of the bacterium that of Actinomyces marimammalium (GenBank Accession no. AJ276405), a new species described in 2001, isolated from two seals and a porpoise. For these reasons a new species, Actinomyces hongkongensis sp. nov., is proposed, for which HKU8(T) is the type strain. Further studies should be performed to ascertain the potential of this bacterium to become an important cause of actinomycosis.

Actinomyces↗
PubMed2006

A case of actinomycosis causing unilateral tonsillar hypertrophy.

We report a case of unusual presentation of actinomycosis in the tonsil causing massive unilateral enlargement in a 78-year-old female. To our knowledge, only three cases of actinomycosis causing unilateral tonsillar enlargement have been published previously. Since this anaerobic organism is difficult to culture, the diagnosis is made by observing its associated sulfur granules in the biopsy specimen. In the present case, treatment consisting of tonsillectomy and antibiotic therapy (penicillin) for several days produced a good prognosis.

Actinomycosis↗
PubMed2000

Primary actinomycosis of the urinary bladder.

Actinomycosis is caused by bacilli of the Actinomyces sp. They are Gram-positive, anaerobic or microaerophilic non-spore-forming bacilli. Actinomyces israelii is the most common aetiological agent. A case is reported of primary actinomycosis in the urinary bladder successfully treated with ceftriaxone.

Actinomycosis↗
PubMed2001

Intra-abdominal actinomycosis with hepatic pseudotumor and xanthogranulomatous pyelonephritis in a 6-y-old boy.

We report the case of a 6-y-old boy with actinomycosis, presenting as xanthogranulomatous pyelonephritis (XGP), hepatic pseudotumor and abdominal abscess. Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology. The patient recovered well with antibiotic alone.

Abdominal Abscess↗
PubMed2002

Hepatic actinomycosis: an overview of salient features and outcome of therapy.

A 34-y-old African-American male developed Actinomyces liver abscess 8 months after appendectomy. Review of the English language literature revealed 56 additional cases of hepatic actinomycosis. Affected patients were typically immunocompetent, had a wide age range (4-86 y) and were predominantly male (70.2%). Infection was frequently (80.7%) cryptogenic, presenting with fever (83.3%), abdominal pain (74.5%) and weight loss (50.9%) over a 3.7 +/- 5.1 month period. The most common radiographic finding was a single hypodense mass/abscess (68.4%). Extension to surrounding tissues was evident in 19 cases (33.3%). Diagnosis was usually accomplished microscopically and culture was often (33.3%) negative. Infection was often (35.2%) mixed, usually with anaerobic bacteria. A surgical or percutaneous approach was diagnostic in 29/35 (82.9%) and 24/33 (72.7%) cases, respectively. The overall mortality rate was 8.8%; it was 10.7% with medical therapy alone and 4.0% using a combined medical/intervention approach (p = 0.6). In conclusion, hepatic actinomycosis is a rare subacute infection that may mimic neoplasm. It is usually cryptogenic, is more common among immunocompetent individuals and male subjects and is highly responsive to medical therapy.

Actinomyces↗
PubMed2004

A childhood case of primary hepatic actinomycosis presenting with cutaneous fistula.

Primary hepatic actinomycosis is extremely rare in children. Although the infection has the capability of extension to surrounding tissues or organs, involvement of the abdominal wall is infrequently reported even in adults. We present a childhood case of primary hepatic actinomycosis infiltrating the anterior abdominal wall and spontaneously draining through the skin.

Abdomen, Acute↗