Lesion Mimicking Lung Tumor / 결핵및호흡기질환

A 75 year old woman was admitted for evaluation of right lung mass. She was not a smoker. She had been diagnosed as uterine prolapse and during preoperative assessment a lung mass was found incidentally on simple chest X-ray. On chest CT scan, 3.5x2 cm sized homogeneous mass was located in the anterior segment of right upper lobe and there were multiple calcified lymph nodes in both hilum and mediastinal area. We performed diagnostic bronchoscopy, but no definite endobronchial mass was found. Next we did CT guided percutaneous fine needle aspiration biopsy. On microscopy, sulfur granules consisting of multiple granular basophilic centers with hyaline projection of branching filaments were noted. From this finding we made a diagnosis of pulmonary actinomycosis.

A Case of Huge Empyema Caused by Pulmonary Actinomycosis / 결핵및호흡기질환

Actinomycosis is an indolent infectious disease characterized by pyogenic response and necrosis, followed by intense fibrosis. The main forms of human actinomycosis are cervicofacial, pulmonary, and abdominopelvic type. Pulmonary actinomycosis accounts for 15% to 20% of total cases and unfortunately, clinical manifestations and radiologic findings are nonspecific. Small pleural effusion or empyema may develop in advanced disease but massive empyema is infrequent and rarely reported. We report a case of huge empyema caused by pulmonary actinomycosis in a 55 year-old man, presented with one-month history of productive cough and fever. The CT scan revealed a huge cavity with air-fluid level occupying the left hemithorax. Empyema caused by actinomycosis was confirmed microscopically by demonstration of sulfur granules in empyema sac through thracotomy. Decortication and surgical resection of empyema sac and destructed lung was accomplished and followed by intravenous infusion of penicillin G.

A case of abdominal actinomycosis simulating Dieulafoy's ulcer / 대한내과학회지

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species and characterized by sulfur granule formation. Depending on the site of primary infection, it is generally classified as cervicofacial, thoracic and abdominal type. Abdominal actinomycosis is often difficult to diagnose before operation because of low frequency and no characteristic clinical features of the disease. As it progresses chronically, it can be misdiagnosed such as cancer, inflammatory bowel disease or other abscess. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. In vast majority of cases, treatment has consisted of long-term antibiotic therapy coupled with surgical resection. We experienced a case of colonic actinomycosis initially diagnosed as Dieulafoy's ulcer and confirmed by colonoscopic biopsy. Treatment with intravenous penicillin for 4 weeks was successful independently, and we report this case with a brief review of literatures.

A case of primary hepatic actinomycosis coinfected with alpha-streptococcus / 대한내과학회지

Actinomycosis is a chronic suppurative and granulomatous disease caused by gram-positive bacteria, the Actinomyces, which normally resides in the mouth cavity and large bowel. Actinomyces and other bacterial species are concomitantly, on occasion, found, having been designated "companion microbes". Designing a therapeutic regimen that includes coverage for "companion microbes" during the initial treatment course is reasonable. Primary hepatic actinomycosis, which was not found in possible source or associated disease and was coinfected with alpha-strepotcoccus, has not yet been reported in Korea. We report a case of primary hepatic actinomycosis coinfected with alpha-streptococcus presenting fever, chill, right upper quadrant abdominal pain as chief complaints in a 63-year-old woman. Primary hepatic actinomycosis was confirmed by identification of the sulfur granule, which was obtained by ultrasonography-guided percutaneous needle aspiration and biopsy.

A Case of Abdominal Actinomycosis Developed in Upper Gastrointestinal Tract / 대한소화기내시경학회지

Actinomycosis is a rare chronic suppurative disease caused by actinomyces species, which are normal flora in the oral cavity and gastrointestinal tract, and characterized by formation of sulfur granule. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. However, abdominal and pelvic inflammations are less frequently observed. Most of abdominal actinomycosis develop after abdominal operation, trauma, inflammatory bowel disease or use of intrauterine devices. The definitive diagnosis was made after histopathological study of the tissues. Treatment is long-term antibiotic therapy. Herein, we report a case of a 69-year-old woman with an unusual form of abdominal actinomycosis after total gastrectomy.

A Case of Abdominal Actinomycosis / 대한소화기내시경학회지

Actinomycosis is a chronic suppurative and granulomatous disease caused by actinomyces species and caracterized by sulfur granule formation which frequently discharged via draining sinus. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. Most of abdominal actinomycosis is developed after abdominal operation, trauma or inflammatory bowel disease and it must be differentiated from colon cancer, amaeboma, chronic appendicitis or intestinal tuberculosis. We report a case of abdominal actinomycosis, preoperatively impressed as colon carcinoma, which was diagnosed by histological study of the operative specimen. Adequate surgical excision and drainage procedure followed by administration of massive dose of penicilline for weeks. In this case we noted secondary abscess formation after surgery of primary disease. Herein we present our experience with reviewed literatures.

Primary Endobronchial Actinomycosis / 결핵

We report a case of a 20-year-old woman who presented with fever, dry cough and pulmonary consolidation at the left upper lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the left upper lobar bronchus with exophytic mass and multiple nodular protruding lesions at the left main bronchus. Endobronchial actinomycosis was confirmed by demonstration of sulfur granule through the bronchoscopic biopsy of nodular lesion. Intravenous administration of penicillin G followed by oral tetracycline therapy for 5 months resulted in complete recovery of symptoms which had been present for 3 months prior to therapy. Infiltrative consolidation on the chest X-ray disappeared and all the lesions shown by bronchoscopy were nearly normalized after 6 months only to remain small nodular remnants at the left main bronchus. Endobronchial actinomycosis should be included in the differential diagnosis of endobronchial mass.

A case of primary hepatic actinomycosis

Actinomycosis is a chronic suppurative and granulomatous disease characterized histologically by sulfur granules with extensive necrosis, fibrosis and sinus formation. Depending on the site of primary infection, actinomycosis is generally classified as cervicofacial, thoracic and abdominal type. The liver is known to be the primary site of infection in 15% with abdominal actinomycosis. The authors have experienced a case of liver abscess in a 24-year-old male. The sono-guided aspiration biopsy revealed findings of infiltration of neutrophils and characteristics sulfur granules by light microscopy. This case was thought to represent an instance of liver actinomycosis. Although there have been a lot of reports on actinomycosis of the liver in other countries, only 3 cases were reported in Korea.

Actinomycosis on left submandibular area: a case report / 영남의대학술지

Actinomycosis is a chronic suppurative and granulomatous bacterial infection characterized by contiguous spread, abscess formation and sinus tract formation. There are four clinical forms according to the lesional site, as 1) cervicofacial, 2) thoracic, 3) abdominal, and 4) disseminated form. Recently, we experienced a case of 54 year-old patient with left mandibular actinomycosis. The pathognomonic findings of actinomycosis is sulfur granule with multiple filaments in Gram-stain and the treatment of actinomycosis is surgical excision of mass or sinus tract with massive antibiotics (esp. Penicillin) therapy for 6 to 12 months.