501/603. Recognition of renal actinomycosis: nephrectomy can be avoided. Report of a case. nephrectomy is performed for the diagnosis and treatment of renal actinomycosis. A cachectic 62-year-old man with a left renal mass underwent exploration and needle biopsy of the mass. No malignant disease was found. When his condition further deteriorated, the kidney was re-explored. Numerous biopsies intraoperatively finally revealed actinomycosis, so the operation was terminated with preservation of the kidney. Long-term treatment with antibiotics was begun with immediate, marked improvement in the patient's condition. At 1 year the renal mass had almost resolved. This is the first reported case of the diagnosis and treatment of renal actinomycosis without nephrectomy. ( info) |
502/603. IUD-associated pelvic actinomycosis: a report of five cases. Five cases of intrauterine device (IUD)-associated tuboovarian actinomycosis are presented. The patients' ages ranged from 33 to 49 years and their IUD usage from 2 to 12 years. Clinical features of the cases included stenosis of the sigmoid colon in 4 cases, ureteric or bladder obstruction in two cases, and rectal fistula in a further instance. All patients were successfully treated postoperatively with penicillin or ampicillin. An initial diagnosis of ovarian carcinoma was considered in all cases. Although actinomyces is difficult to differentiate histopathologically from microorganisms and other substances that cause the Splendore-Hoeppli phenomenon, morphological diagnosis permits a quicker and more practical approach than bacterial cultures in the establishment of postoperative antibiotic treatment. Intraoperative frozen-section diagnosis of an acute inflammatory process permits the surgeon to make an immediate decision in order to avoid extensive surgery when ovarian carcinoma is suspected. ( info) |
503/603. Invasive mycotic and actinomycotic oropharyngeal and craniofacial infection in two patients with AIDS. Two cases of invasive oropharyngeal and craniofacial infection caused by fungal and actinomycotic pathogens are described in hiv-infected patients. Two women with a previous diagnosis of AIDS, one with non-Hodgkin's lymphoma and one with candida oesophagitis, developed a subacute, invasive inflammatory process characterized by ulcerative necrotizing lesions spreading from the oropharynx up to the soft and hard palate, maxillary sinuses and nasal cavity, with extensive soft-tissue necrosis. Although presenting with a very similar clinical picture, infection was due to actinomyces spp. in the first case, while an apparent dual fungal aetiology (aspergillus flavus and candida spp.) was demonstrated in the second patient. Both cases were characterized by remarkable diagnostic difficulties leading to a late final recognition (confirmed by histological examination), and by a partial response to antimicrobial treatment. ( info) |
| Endobronchial actinomycosis was found to be the cause of right-sided atelectasis and haemoptysis in a 57 year old man without predisposing conditions. Fibreoptic bronchoscopy revealed occlusion of the intermediate bronchus by yellow-white masses. The diagnosis was confirmed histologically and by positive actinomyces culture from bioptic material. Prolonged antibiotic treatment resulted in complete recovery, without need for surgical resection. ( info) |
505/603. skin lesions and an intrathoracic mass. We describe a case of thoracic actinomycosis in a previously healthy man. The clinical features were a paramediastinal mass with skin lesions due to haematogenic dissemination. After parasternal mediastomy, the diagnosis was made. After treatment with penicillin, there was complete recovery. ( info) |
506/603. Bilateral pulmonary infiltrates in association with disseminated actinomycosis. The most common infectious cause of bilateral upper-lobe pulmonary disease is tuberculosis. However, we recently encountered a patient with bilateral apical infiltrates and multiple soft-tissue abscesses caused by actinomyces odontolyticus. Other findings included fever, weight loss, and leukocytosis, and the patient's only known source of immunosuppression was a long history of alcoholism. There was no history of diabetes, steroid use, or other chronic underlying disease. The diagnosis was made by culture of drainage fluid from one abscess. Therapy with intravenous penicillin g led to rapid clinical improvement and reduction in the infiltrates. To our knowledge, the presentation of pulmonary infection, with bilateral apical infiltrates due to A. odontolyticus has not been previously reported in the medical literature. ( info) |
507/603. Successful treatment of thoracic actinomycosis with ceftriaxone. We report the case of a 38-year-old woman who had pulmonary actinomycosis that involved the pleura and the pectoral muscles. The patient was initially treated with intravenous ceftriaxone once a day on an outpatient basis. After 3 weeks of treatment, a computed tomogram showed resolution of the initial findings. This result suggests that ceftriaxone may be an effective and convenient therapeutic agent for the initial parenteral treatment of actinomycosis. ( info) |
508/603. Pelvic actinomycosis presenting with a rectal stricture: report of a case. We present herein the case of a patient with actinomycosis involving the pelvic cavity, who presented with a rectal stricture. It is rare for this type of actinomycosis to be accurately diagnosed preoperatively, but a precise diagnosis, made using needle biopsy guided by computed tomography allowed for successful treatment by resection of the granulation tissue surrounding the rectal stricture through a transsacral approach. ( info) |
| pleural effusion represents an unusual but significant manifestation of actinomycosis, as illustrated in this case presentation. The diagnosis was made after bronchoscopy and examination of bronchoalveolar fluid and culture. No parenchymal abnormality was noted on the chest film. ( info) |
510/603. Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. The bacterial species found in pus aspirated from brain abscesses in two patients were typical of those found in dental sepsis. Subsequently apical-root abscesses were demonstrated in the upper jaws of both patients. This evidence strongly suggests that these cerebral abscesses were secondary to dental sepsis which could have spread from the teeth to the frontal lobes by several possible antaomical pathways. ( info) |