Actinomycosis presenting as an isolated pleural effusion in a patient with an HIV infection: a case report and literature review

Background Thoracic actinomycosis is an uncommon, chronic, and progressive infection, especially in patients with HIV. We report a case of thoracic actinomycosis presenting as an isolated pleural effusion in a patient with an HIV infection. Case presentation A 68-year-old patient with progressive dyspnea and fever was admitted. On the right side, an ipsilateral massive pleural effusion was confirmed on the chest radiograph, and an HIV infection was newly diagnosed. A pleural biopsy was performed for the further differential diagnosis of potential opportunistic infections and malignancies. The pathology findings were consistent with actinomycosis. Conclusions Active diagnostic approaches such as a pleural biopsy should be considered for indeterminate pleural effusions in immunocompromised patients.

Actinomyces as a Cause of Unexplained Fever Diagnosed by Next-Generation Sequencing: Case Report and Review

Background: Actinomycosis is a rare cause of unexplained origin fever (FUO). The NGS, particularly in cases of FUO in conventional microbiology, is a promising and advantageous technology for earlier diagnosis and more success. It gives new insights in the management of FUO, especially in infectious diseases.Case presentation: We present a case of a 71-year-old woman who had FUO that the etiology was endobronchial actinomycosis eventually diagnosed by next-generation sequencing of bronchoalveolar lavage fluid. She was admitted to the our department with intermittent fever up to 40.0℃, chills, cough with white sputum, chest distress and slightly dyspnea over one month. According to special clinical course and laboratory data of the patient, she was given intravenous sulbenicillin sodium for 11 days and oral amoxicillin at 500 mg every 8 h for another 1 month. When she returned for follow-up, she reported a notable improvement in her cough, dyspnea, sputum production and fever that was completely absent.Conclusion: In obscure causes of FUO, clinicians should consider the possibility of thoracic actinomycosis and actively use next-generation sequencing to help diagnose.

CASE OF THORACIC ACTINOMYCOSIS IN A CHILD

A. Rechkina, N. V. Promskaya, I. V. Liskina, O. M. Kravtsova Abstract The article presents a rare clinical case of a complex way of diagnosis and treatment of thoracic actinomycosis with lung and chest soft tissues lesions in 12 years old child. About six months passed from the time of the first complaints until the final clinical diagnosis was made. This delay led to significant destructive changes in the lungs and adjacent soft tissues. During this time, the child went through all stages of health care. Differential diagnosis with lung neoplasm was performed. The diagnosis was verified by histological and immunohistochemical studies. The biopsy material revealed separately rounded dense clusters of fungi, which morphologically most corresponded to actinomycetes. The treatment consisted of two stages (inpatient and outpatient), which lasted more than three months. Significant clinical and radiological improvement has been achieved. The child continues treatment on an outpatient basis under the regular supervision of a pulmonologist. Key words: thoracic actinomycosis, diagnosis, treatment, children. Ukr. Pulmonol. J. 2021;29(3):48–52.

Painful thoracic swelling in a refugee teenager

CaseA 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sternal region. The lesion was reddish, warm, tender and painful (figure 1). Digital clubbing was also noticed. The remaining examination was normal. White blood cell count was 9000 cells per mm3, haemoglobin 145 g/L, erythrocyte sedimentation rate and C reactive protein were normal as well as renal and liver function tests. ECG was regular.Figure 1Swelling in the sternal region.Question 1Based on the clinical picture, laboratory tests and history, what is the most likely diagnosis?Chest wall tuberculosisLymphomaThoracic actinomycosisInfected haematomaQuestion 2Which is the best diagnostic test to confirm this diagnosis?Ultrasound scanMRICTChest radiographQuestion 3What is the mainstay of the management of this condition?Drainage of the abscessAntitubercular chemotherapyAspiration of the abscess and antitubercular chemotherapyHyperbaric oxygen therapyAnswers can be found on page 02.

Actinomyces Meyeri Empyema Necessitatis—A Case Report and Review of the Literature

Pleural empyema necessitatis caused by Actinomyces meyeri is a rare but severe infection. A. species predominantly A. meyeri and A. israelii represent the second most common pathogen for empyema necessitans after mycobacteria. The incidence is reported in the literature to be 1:300,000. Men are thrice more likely to be affected than women. Pathogenetically, an infection can be triggered by aspiration in immunocompromised individuals which leads to an atelectasis with pneumonitis.In two cases, a 38-year-old construction worker and a 61-year-old woman with ulcerative breast carcinoma, who presented to the local emergency department with a painful swelling of the left chest, diagnostic workup revealed a pleural empyema necessitatis of the left chest. An antibiotic treatment was initiated with piperacillin/tazobactam and sulbactam/ampicillin, respectively. Temporally vacuum-dressing therapy was initiated after surgical debridement. In the course of the procedure, a reconstruction of tissue damage was feasible. The patients were recovered completely and discharged with an oral antibiotic treatment (amoxicillin) for 6 and 12 months, respectively.Thoracic actinomycosis is a relatively uncommon and traditionally chronic, indolent infection secondary to pulmonary infection with A. species. Surgical treatment is generally reserved for cases failing to resolve with antibiotic therapy. Early diagnosis, prompt debridement, and narrow spectrum β-lactam antibiotics can result in complete resolution of infection and good prognosis.