Pleural effusion as the major manifestation of actinomycosis

A rare diagnosis of pulmonary actinomycosis by bronchoalveolar lavage cytology

The role of a bronchoalveolar lavage sample cell block in the diagnosis of pulmonary actinomycosis.

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.

Pulmonary actinomycosis: cytomorphological features

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings.  Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules.

Unusual aetiology of lymphocyte-predominant exudative pleural effusion: primary mediastinal actinomycosis

Actinomycosis is a rare infectious bacterial disease typically involving cervicofacial, abdominopelvic, or thoracic regions, caused by Actinomyces species. However, involvement of the mediastinum as the primary site of origin is extremely rare. An elderly patient complained of left-sided chest pain. The chest radiograph revealed pleural effusion, which revealed lymphocyte-predominant exudates. Chest computed tomography showed a soft tissue mass in the left anterior mediastinum. Positron emission tomography revealed an increased uptake of 18F-fluorodeoxyglucose in this lesion. To exclude malignancy and make a confirmative diagnosis, a mediastinal biopsy was performed through video-assisted thoracic surgery. Finally, mediastinal actinomycosis was diagnosed. We report herein a case of mediastinal actinomycosis mimicking lung malignancy presented with recurrent lymphocyte-predominant pleural fluid exudate. In patients with a recurrent or unexplained exudative pleural effusion, it may be worthwhile to consider a hidden foci of actinomycosis.

Pulmonary diseases with imaging findings mimicking aspergilloma

Patients with preexisting lung cavities are at risk of developing intracavitary fungal colonization. Because Aspergillus spp. are the most commonly implicated fungi, these fungal masses are called aspergillomas. Their characteristic "ball-in-hole" appearance, however, may be found in a variety of other conditions that can produce radiologic findings mimicking aspergilloma. In this paper, we review the main diseases that may mimic the radiographic findings of aspergilloma, with brief descriptions of clinical, radiologic, and histopathologic findings.

Actinomicose pulmonar com envolvimento da parede torácica

A Actinomicose é uma infecção rara, crônica, supurativa e granulomatosa que pode envolver diversos órgãos. A infecção pulmonar geralmente está relacionada à imunodepressão e à saúde bucal precária. O envolvimento torácico é incomum (10 - 20%), a parede torácica é acometida em apenas 12% destes casos. No presente trabalho, é descrito o caso de um paciente de 26 anos, não HIV e sem co-morbidades, assintomático respiratório, com massa infra-escapular, de crescimento progressivo, muito dolorosa, com sinais locais flogísticos, sem trauma local, apresentando febre persistente, com três meses de evolução. O diagnóstico inicial foi de neoplasia de partes moles de parede torácica. À biopsia incisional da referida massa, houve saída de secreção gelatinosa vinhosa com grânulos amarelados, sugestivos de actinomicose, sendo confirmado por exame anatomopatológico. Empiricamente foi instituída ciprofloxacina devido alergia à cefalosporina. Houve excelente resposta clínica à drenagem externa e à medicação prescrita. Não houve recaída da doença em 18 meses de seguimento.

Actinomycosis: an often forgotten diagnosis

We report a case of actinomycosis presenting as a chest wall mass in a 35 year-old man. Thoracic actinomycosis poses a diagnostic challenge to clinicians not only because it is uncommon and often forgotten, but also because culture of the causative microbes is technically difficult. The classic microscopic appearance of this Gram-positive bacteria associated with surrounding sulfur granules often forms the basis of diagnosis.

Thoracic actinomycosis (arcanobacteriosis) or nocardiosis causing thoracic pyogranuloma formation in three dogs

OBJECTIVE

To describe three cases of canine thoracic actinomycosis (arcanobacteriosis) or nocardiosis in which the primary pathological lesion was a pyogranulomatous abscess in the mediastinum. Clinical signs, difficulties in diagnosis, treatment and prognosis are examined. Comparisons are made between human and veterinary literature to assist in formulating a rational treatment plan.

DESIGN

Retrospective clinical study.

PROCEDURE

Review of case records from 1984 to 1998.

RESULTS

Three dogs presented with large intrathoracic pyogranulomas producing variable clinical signs, not necessarily associated with the respiratory tract. Ages ranged from 2 to 5 years old. Two dogs responded to surgical opening and passive drainage of the abscess, or surgical excision of the granuloma with associated structures, and medical therapy. One dog died intra-operatively.

CONCLUSION

A combination of surgical and antimicrobial therapy may carry a fair-to-good prognosis for thoracic granuloma caused by actinomycosis (arcanobacteriosis) or nocardiosis. The extent of surgery should be based on assessment of individual cases and must include surgical biopsy for histology and culture to enable a specific diagnosis to be made. Complete surgical excision is not necessarily required. Prolonged antimicrobial therapy is indicated.

Unusual presentation of cervicothoracic actinomycosis complicated by pericardial effusion: a case report

Actinomycosis is a chronic-suppurative disease characterized by abscesses and draining sinus tracts, with fibrosis and granulation involving the face and neck and thoracic or pelvic-abdominal regions. Dermatological findings in patients at high risk are the key to the correct diagnosis. Actinomycosis is frequently undiagnosed or misdiagnosed until the correct diagnosis is made after surgical resection. Alcoholic, homeless, and disadvantaged individuals and patients with other factors predisposing to infection including poor dentition, alcoholism, seizures, and trauma are common in the emergency department; thus, emergency physicians should be aware of the different presentations and complications of this disease. The treatment of choice is a high dose of penicillin in conjunction with surgical debridement. The prognosis is excellent with correct diagnosis and therapy.