Document Type : Case Report
Authors
1
Assistant Professor, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2
Professor, Department of Otolaringology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3
Associate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4
Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
5
Medical Student, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
Background: Actinomycosis is an indolent, slowly progressive infection caused by non acid fast,gram positive, anaerobic or microaerophilic bacteria. The most common site of actinomycosis infectionis cervicofacial region. Bacteriologic identification from infected site or detection of sulfur granulesconfirms the diagnosis. We report a rare case of simultaneous infection of larynx and lungs actinomycosiswith various radiologic manifestations including diffuse right lung cavitation as a very rarefinding.Case report: A 77-year-old man was admitted with complaints of fever and productive cough andweight loss, for one month, from the time he had been undergone open heart surgery.On that time, aftersurgery, he had been intubated for a long time because of decreased level of o2 saturation. Respiratoryfailure reason was not determined, so laryngeal CT scan was done with suspicious to a pathological lesion;it showed a mass in the larynx. Pathological findings of the laryngeal biopsy showed sulfur granuleformation of actinomyces. Lung spiral CT scan revealed speculated margin pulmonary nodules with fibroticchanges and cavitary lesion. Pathology of lung biopsy showed; multiple granuloma consist of epithelioidand mononuclear cells with fibrosis, there were no sign of caseous necrosis or fungal infection inPAS staining and no acid fast bacilli were seen. Cytological evaluation for malignancy was also negative.He was treated with high dose of penicillin and in his follow up, he clinically and paraclinically gotbetter.Conclusion: Although pulmonary and laryngeal actinomycosis is rare, but should be considered inrecurrent and persistent infections specially in patients with history of long stay hospitalization. It is indifferential diagnosis with the all chronic lung infections and malignancies. Because of good responseto appropriate antibiotic therapy and preventable complications, early diagnosis is mandatory.
Keywords
)