A Rare Case of Laryngeal and Pulmonary Actinomycosis Co-Infection



Meidani M¹ ; Berjis N² ; Mokhtari M³ ; Ahmadi N⁴ ; Rikhtegar MH⁵ ; Rikhtegar MJ⁵ Show Affiliations
Source: Journal of Isfahan Medical School Published:2011

Abstract

Background: Actinomycosis is an indolent slowly progressive infection caused by non acid fast, gram positive, anaerobic or microaerophilic bacteria that normally colonize the mouth, colon, and vagina. The most common location of actinomycosis infection is cervicofacial region. Bacteriologic identification from infected site or detection of sulfur granules confirms the diagnosis. Pulmonary actinomycosis is rare and should be considered in recurrent and resistant infections. It can mimic a number of other conditions such as malignancy. Laryngeal actinomycosis is rare too. We report a rare case of laryngeal and pulmonary actinomycosis co-infection with various radiological manifestations such as predominant cavitation in right lung. Case report: A 77-year-old man was admitted with complains of fever and productive cough and weight loss, for one month. He had a history of prolonged smoking (40 pack-years) and had been undergone open heart surgery. He was intubated for a long time after surgery because of respiratory failure and decreased level of O2 saturation. Laryngeal CT scan was done with suspicion to a pathological lesion; it showed a mass in the larynx. Laryngoscopy was done and biopsy was taken. Pathological findings of the lesions showed sulfur granule formation of actinomyces. He also suffered from fever, chills, and yellow colored sputum. Spiral CT scan with contrast was done for him that revealed fibrotic band and pleural thickening mostly in upper hemi thorax and in right side. There were also multiple bilateral speculated margin pulmonary nodules with fibrotic changes which one of them in right lung apex had been cavitated. Pathology of lung biopsy showed multiple granoloma consist of epitheloid and mononuclear cells with fibrosis; there was no sign of caseos necrosis or fungal infection in PAS staining and no acid fast basil was seen. Cytological evaluation for malignancy was also negative. He was treated with high dose of penicillin and in his follow-up, he got better clinically and para clinically. Conclusion: Although pulmonary or laryngeal actinomycosis is rare, but should be considered in the differential diagnoses of a subacute pulmonary infection. It can also mimic malignancy. Early diagnosis is important because the response to antibiotics is good and complications can be nnprevented.