Abstract
We describe a patient who presented with neurological symptoms and radiological findings consistent with metastatic malignancy in several sites. However, no obvious primary site of tumour was identified and the patient later went on to develop clinical features of sepsis whilst using palliative dexamethasone therapy. A diagnosis of actinomycosis was eventually made on open lung biopsy and the patient recovered completely on penicillin V. This case serves to illustrate the need to obtain a formal tissue diagnosis whenever possible in all cases of suspected malignancy, in addition to exposing the weaknesses inherent in empiric diagnoses.
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]
References
- Dominguez DC, Anthony SJ. Actinomyces and Nocradia infections in immunocompromised and nonimuunocompromised patients. J Natl Med Assoc 1999; 91: 35-9.
- Greaves H. The bacterial factor in wood decay. Wood Science and Technology 1971; 5: 6-16.
- Smego Jr R, Foglia G. Actinomycosis. Clin Infect Dis 1998; 26:1255-61.
- Oostman O, Smego Jr R. Craniofacial actinomycosis: diagnosis and management. Curr Infect Dis Reports 2005; 7: 17-174.
- Russo TA. Agents of actinomycosis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 7th ed. Elsevier Churchill Livingstone, 2010: 3209-19.
- Acevedo F, Baudrand R, Letelier L, Gaete P. Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature. Int J Infect Dis 2008; 12: 358-362.
- Lohani S, Chadwick P, Armstrong G, BR O’Driscoll, Taggart SCO. Endobronchial mimics of lung cancer. Journal of Bronchology 2005; 12(1): 56-58.
- Tastepe AI, Ulasan NG, Liman ST et al. Thoracic actinomycosis. Eur J Cardiothoracic Surg 1998; 14(6): 578-83.
- Espina MA, Lopez-Menendez C, Ruiz-Martinez R et al. Pulmonary actinomycosis with thoracic soft tissue mass: a rare onset form. Eur J Radiol 2001; 37: 195-9.
- Xu GP, Xu ZD Gao BL et al. Cervical actinomycosis with spinal cord compression. Chemotherapy 2008; 54: 63-66.
- Martin MV. Antibiotic treatment of cervicofacial actinomycosis for patients allergic to penicillin: a clinical and in vitro study. Br J Oral Maxillofac Surg 1985; 23: 428-34.
Request Permissions
To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:
