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PubMed1993

Thoracic actinomycosis.

Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiographic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. From 1984 to 1990, we experienced 17 cases of thoracic actinomycosis. There were nine patients who presented with a clinical picture of a suppurative lesions and the remaining eight were suspected of having primary lung tumor initially. In no case was an accurate diagnosis made at the time of hospital admission. Final diagnosis was based on aspiration (n = 3), anaerobic sputum culture (n = 1), bronchoscopic biopsy specimens (n = 4), and histologic examination of the resected tissue in the remaining 9 patients who received surgical excision. Among the 17 patients, 8 were treated medically and the other 9 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation (seven of nine). However, both medically and surgically treated patients achieved good clinical results, and the postoperative courses were uneventful. We would like to remind physicians of this unusual entity and review our own experience with particular emphasis on the clinical diagnosis and management of this unique disease.

Actinomycosis↗
PubMed2001

Utility of Wang needle aspiration in the diagnosis of actinomycosis.

An 85-year-old man had a 4-year history of recurrent pneumonia with a persistent pleural effusion. He underwent repeated bronchoscopy that revealed a right bronchus intermedius mass, but bronchial washes and biopsies remained nondiagnostic. A repeat bronchoscopy was performed, and a Wang needle aspiration of the mass was obtained that showed sulfur granules, diagnosing actinomycosis. The patient was started on appropriate antibiotic therapy. Actinomycosis must be considered in a patient with recurrent pneumonia and an endobronchial mass. Wang needle aspiration via bronchoscopy may be an important diagnostic tool.

Actinomycosis↗
PubMed2004

Gastric actinomycosis: a rare complication after gastric bypass for morbid obesity.

A 41-year-old woman in November 2002 underwent a gastric bypass by the Capella technique for morbid obesity. Almost 1 year after the surgery, she developed severe vomiting. Radiological studies confirmed a severe stenosis of the gastrojejunal anastomosis. Two pneumatic dilatations of the stenosis failed. In February 2004, she underwent resection of the stenotic anastomosis. Histology showed an intact mucosa and beneath it an abscess filled with numerous filamentous microorganisms, with typical features of Actinomyces. With the diagnosis of gastric actinomycosis, she received a postoperative course of antibiotherapy with imipenem and was discharged after an uneventful recovery. Gastric actinomycosis is a rare infection, of which only 19 additional cases have been reported in the literature. To our knowledge, this is the first case to affect a patient following batriatric surgery. The reported cases of this entity are reviewed, and the diagnostic criteria that could avoid surgery in these cases are discussed.

Actinomycosis↗
PubMed1984

Pulmonary actinomycosis of periodontal origin.

A case of pulmonary actinomycosis of periodontal origin is presented. Microbiologic testing including culture and typing of multiple systemic and oral lesions revealed the presence of Actinomyces naeslundii and A viscosus in all sites. In addition, biopsies demonstrating branching filamentous forms and "sulfur granules" were found in exudates from the lungs, submandibular region and left quadrants of the oral cavity. Seeding of tooth-associated materials containing Actinomyces sp into the pulmonary field may have resulted in this case of pulmonary actinomycosis. Therapy of the pulmonary and periodontal infections was completed and the patient is maintaining satisfactory health 18 months later.

Actinomycosis↗
PubMed2000

Case report of regional alveolar bone actinomycosis: a juvenile periodontitis-like lesion.

BACKGROUND: Cervicofacial actinomycosis infection most often involves the mandibular bone and rarely the alveolar crest. METHODS: We describe a 14-year-old patient who had actinomycosis involving the alveolar bone at the left lower dental quadrant region. Resembling juvenile periodontitis, it was difficult to diagnose properly and resulted in devastating dental and periodontal consequences: loss of one tooth with most of its adjacent regional alveolar bone, severely compromising the support of two other teeth. RESULTS: With the diagnosis came successful treatment, including surgical removal of the soft and hard tissues with concomitant prolonged penicillin administration. CONCLUSIONS: We feel that this case should raise the interest and concern of both the periodontist and the general practitioner so that early diagnosis can be obtained, significantly improving the clinical outcome.

Actinomycosis, Cervicofacial↗
PubMed1989

Thoracic actinomycosis.

Nine cases of thoracic actinomycosis treated in the period 1966-1987 are reported. Three of the patients presented with a clinical picture of empyema and six were admitted for suspected primary pulmonary neoplasm. No case was correctly diagnosed preoperatively. The final diagnosis was based on direct microscopy (2) or culture (1) of drained pus in the empyema cases and on histologic examination of resected tissue in the others. In one case the correct diagnosis was missed when a palpable tumour mass was not extirpated at exploratory thoracotomy, and was made only when clinical deterioration necessitated a second operation. Good clinical results can be expected from surgical eradication of an intrathoracic focus of actinomycosis in conjunction with appropriate antibiotic therapy.

Actinomycosis↗
PubMed2002

Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. Case report.

The authors report the successful treatment of a 42-year-old man who suffered from recurrent painful ophthalmoplegia caused by bilateral cavernous sinus (CS) actinomycosis. A presumptive diagnosis of Tolosa-Hunt syndrome was made when he presented with left painful ophthalmoplegia. Recurrent ophthalmoplegia on the opposite side when steroid medications were tapered led to repeated imaging and a pterional craniotomy and biopsy sampling of the CS. These tests demonstrated acute inflammation and sulfur granules, which responded clinically and radiologically to parenterally administered penicillin therapy. Actinomycosis may present as a painful ophthalmoplegia with involvement of one or both CSs. Repeated imaging and possibly surgical exploration may be necessary to make a definitive diagnosis.

Actinomycosis↗
PubMed2006

Plasma cell granuloma associated with pulmonary actinomycosis: a case report.

Plasma cell granuloma (PCG) of the lung is a rare disease that usually presents as a pulmonary nodule or mass on incidental radiographic examination without symptoms. Although the etiology of PCG is still controversial, many findings have lent support to the lesion being a reactive inflammatory process rather than a neoplastic one. We describe a 53-yr-old male who presented with a hemoptysis and have a lung mass at the left upper lobe on chest radiograph. The lung mass was primarily diagnosed as PCG by percutaneous needle aspiration and biopsy, and the patient was treated with oral steroid because he and relatives refused the operation. However, the size of the lung mass did not change and open thoracotomy and lobectomy were done therefore. He was confirmed as having pulmonary actinomycosis with PCG after surgery. To our knowledge, this is the first report of PCG associated with actinomycosis in Korea.

Actinomycosis↗
PubMedDate not supplied

Mycotic pulmonary artery aneurysm as an unusual complication of thoracic actinomycosis.

Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis and generalized vasculitis. To our knowledge, mycotic aneurysms caused by pulmonary actinomycosis have not been reported in the radiologic literature. Herein, a case of pulmonary actinomycosis complicated by mycotic aneurysm is presented. On CT scans, this case showed focal aneurysmal dilatation of a peripheral pulmonary artery within necrotizing pneumonia of the right lower lobe, which was successfully treated with transcatheter embolization using wire coils.

Actinomycosis↗
PubMed2006

Abdominal actinomycosis associated with a sigmoid colon perforation in a patient with a ventriculoperitoneal shunt.

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved.

Abdominal Pain↗
PubMed2005

Actinomycosis mimicking recurrent carcinoma after Whipple's operation.

Actinomycosis is a rare, chronic, spreading, suppurative, granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple's operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.

Actinomycosis↗
PubMed2002

Foreign body-induced actinomycosis mimicking bronchogenic carcinoma.

Actinomycosis is a slowly progressive infectious disease caused by an anaerobic and microaerophilic bacteria that colonizes the face, neck, lung, pleura and the ileocecal region. There have been a few cases of this disease which have involved in the lung but one very rare case has been reported. We report a case of foreign body-induced endobronchial actinomycosis mimicking bronchogenic carcinoma in a 69-year-old man. On admission, the patient presented with weight loss, cough and hemoptysis. The fiberoptic bronchoscopy revealed a soft tissue mass, with a partial occlusion of the left upper bronchus, which resembled bronchogenic carcinoma. Contrary to the first impression, the biopsy of the bronchus revealed the mass lesion to be an actinomycotic infection involving the bronchus. After the confirmation of the lesion, treatment with penicillin was initiated. The follow-up bronchoscopy revealed an aspirated fish bone at the site of infection. The foreign body was safely removed.

Actinomycosis↗
PubMedDate not supplied

Empyema necessitatis: review of the manifestations of thoracic actinomycosis.

Actinomycosis is a relatively uncommon infectious process involving the chest. A case of thoracic actinomycosis mimicking an inflammatory breast carcinoma in an elderly woman is presented with a review of the literature. The authors suggest that considering this disease in the differential diagnosis of indolent pulmonary parenchymal and pleural lesions is essential if appropriate diagnostic tests are to be obtained and proper therapy initiated, thus avoiding unnecessary invasive procedures.

Actinomycosis↗
PubMed2006

A new form of presentation of renal actinomycosis: renal tumor with retroperitoneal bleeding.

OBJECTIVE: The aim of this case report is to add to the literature a new case of renal actinomycosis, but with a form of presentation that has never been reported: renal tumor with retroperitoneal bleeding. METHODS/RESULTS: We present the case of a 27-year-old woman, with a 5-month history of general syndrome and right flank pain. Radiological findings showed a right renal tumor with suspicious of retroperitoneal bleeding. Right radical nephrectomy was performed and the pathological examination of the specimen found actinomyces colonies. The patient received 8 weeks of Penicillin after surgery and had none sequelae. easily diagnosed because of non-specific clinical and radiological findings. Early diagnosis of renal actinomycosis is important to avoid surgery since actinomyces respond well to high doses of Penicillin.

Actinomycosis↗
PubMed1999

[A case of renal actinomycosis].

A case of renal actinomycosis is reported. A 63-year-old man was admitted to our hospital for further examinations of a right renal mass, complaining of dull pain in his right loin and progressive weight loss. Laboratory findings showed an anemia with a grossly raised ESR, CT, MRI and ultrasonography revealed a solid mass of the right kidney. Chest CT films revealed several infiltrates in the bilateral lobes. A diagnosis of neoplasm or inflammatory mass of the right kidney was considered, and the right nephrectomy was performed. Microscopically, characteristic colonies of actinomyces were seen, and histological diagnosis was renal actinomycosis. The patient made good progress after operation and was subsequently treated with penicillin.

Actinomycosis↗
PubMed1998

[Clinical and radiological study of pulmonary actinomycosis].

We clinically and radiologically examined 8 patients with pulmonary actinomycosis. Their clinical features were slowly progressive, and the most commonly occurring symptom was hemoptysis. Laboratory findings disclosed elevated ESRs, a sign of chronic inflammation. Roentgenographic films showed a higher percentage of lesions in the right lung and on the dorsal side. On chest CT images, the lesions appeared as nodular or consolidated shadows with atelectasis, and spread widely over the parietal pleura in the periphery of the lung fields. The margins of the nodules were irregular, and multiple blood vessels were involved. The internal density of the nodules contained either a low attenuation region or cavity. In relation to the pleural, local pleural thickening adjacent to the nodules was identified in all patients, and the thickened areas were thin and smooth. Although it was difficult to diagnose by transbronchial lung biopsy (TBLB), granulation tissue obtained by TBLB was considered an important finding suggestive of pulmonary actinomycosis. As diagnostic procedures, repeated TBLBs appear to be effective for lesions extending into the hilar region, and video-assisted thoracoscopic surgery, for small nodular lesions located in the periphery of the lung fields.

Actinomycosis↗
PubMed1999

[Pelvic tumoral actinomycosis: a difficult diagnosis. Two case reports].

Two cases of intra-uterine device-associated occlusive pelvic pseudo-tumoural actinomycosis are presented. A pre-operative diagnosis of ovarian carcinoma was considered in both cases and lead to a wide and difficult surgery. Actinomycosis was confirmed by the postoperative histopathologic examination, and the patients were successfully treated with penicillin. The difficulties and limits of the clinical and histopathological diagnosis are exposed. The interest of the pre and intra-operative diagnosis which can avoid an extensive surgery with high morbidity is highlighted.

Actinomycosis↗
PubMed1999

[Thoracic actinomycosis--a case report].

BACKGROUND: Actinomycosis is caused by a variety of gram-positive anaerobic or microaerophilic rods belonging to the genus Actinomyces or Propionibacterium. The production of suppurative abscesses or granulomas that eventually develop draining sinuses are hallmarks of the disease. We describe the case of a 55 year old smoker who presented himself 4 months ago with right thoracic pain and an unproductive cough. He developed a warm, red mass in the lower part of the right thorax. We performed an ultrasound guided needle aspiration and the pathologic examination revealed typical sulfur granules and masses of neutrophils in the aspirate. After surgical resection of the abscess and under high-dose therapy with penicillin G the further course of disease was uneventful. CONCLUSIONS: Although uncommon, thoracic actinomycosis should always taken into account in the differential diagnosis of chronic inflammatory processes that involve the pulmonary parenchyma or pleural space.

Actinomycosis↗