A case of thoracic actinomycosis presenting as sudden paraplegia

Peiffer-Smadja, Nathan; Harent, S.; Messeca, Clément; Lechapt‐Zalcman, Emmanuèle; Yazdanpanah, Yazdan; Joly, Véronique

doi:10.1016/j.neurol.2018.01.380

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…Because this organism behaves like the more common actinomycetes, treatment guidelines for actinomycosis are followed. Generally, mild actinomycosis is treated with initial oral therapy, but severe or extensive disease, such as thoracic actinomycosis, requires parenteral therapy for 2–8 weeks followed by oral therapy for 6–12 months, with or without surgical source control [ 35 , 36 ]. The preferred regimen for severe actinomycosis involves high-dose penicillin, generally 18–24 million units daily for 2–6 weeks, followed by oral therapy with penicillin V or amoxicillin for 6–12 months.…”

Section: Discussionmentioning

confidence: 99%

Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing

Babar,

Liu,

Kaur

et al. 2024

Pathogens

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Pseudopropionibacterium propionicum (P.p.) is an anaerobic, Gram-positive, branching beaded rod that is a component of the human microbiome. An infection of the thoracic cavity with P.p. can mimic tuberculosis (TB), nocardiosis, and malignancy. We present a case of a 77-year-old male who presented with dyspnea and a productive cough who was initially misdiagnosed with TB based on positive acid-fast staining of a pleural biopsy specimen and an elevated adenosine deaminase level of the pleural fluid. He was then diagnosed with nocardiosis based on the Gram stain of his pleural fluid that showed a Gram-positive beaded and branching rod. The pleural fluid specimen was culture-negative, but the diagnosis of thoracic P.p. infection was determined with next-generation sequencing (NGS). The patient was initially treated with imipenem and minocycline, then ceftriaxone and minocycline, and later changed to minocycline only. This report shows the utility of NGS in making a microbiological diagnosis when other techniques either failed to provide a result (culture) or gave misleading information (histopathologic exam, pleural fluid adenosine deaminase determination, and organism morphology on Gram stain).

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Section: Discussionmentioning

confidence: 99%

Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing

Babar,

Liu,

Kaur

et al. 2024

Pathogens

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“…Actinomycosis, caused by Actinomyces species, was first described by Israel in 1878 (7). Intraspinal actinomycosis is a very rare disease, and only 29 cases have been reported so far (8,9). The majority of patients with intraspinal actinomycosis are immunocompetent (8).…”

Section: Discussionmentioning

confidence: 99%

“…Standards for antimicrobial treatment of intraspinal actinomycosis have not yet been established. Intravenous administration of high doses of penicillin G or amoxicillin for 4-8 weeks is preferred, and continued treatment of oral antibiotics for 6-12 months is usually recommended to prevent relapses and local complications (9,10). Nonetheless, the complete resolution of symptoms has been described in only 50% of the reported cases (17).…”

Section: Discussionmentioning

confidence: 99%

Spinal Intrathecal Actinomycosis Causes Multisegmental Root Failure: A Case Report

et al. 2020

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Actinomycosis is a slowly progressing infection caused by Actinomyces species, which consists of filamentous gram-positive bacteria. Intraspinal actinomycosis is very rare and most of the previous cases presented with epidural lesions. Only two cases of intrathecal actinomycosis have been described. We reported a case of intrathecal actinomycosis in a 46-year-old woman. Our patient presented with multisegmental root failure, which was different from previous intrathecal cases mainly involving the spinal cord. The manifestations, cervical MR imaging results, biopsy and histopathological features, and treatment history of the patient were reviewed. Clinical features of this disease resemble intraspinal neoplasms, other infectious processes, and granulomatous diseases, thus being difficult to diagnose preoperatively. Histopathological evidence from the biopsy is important for timely diagnosis. Early diagnosis and treatment may greatly improve the prognosis.

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“…It is important to recognize that P. propionicum can cause thoracic actinomycosis and will likely require the prolonged treatment course typical for actinomycotic disease; i.e., 2 to 8 weeks of intravenous antibiotic therapy followed by 6 to 12 months of oral antibiotic therapy [22,23].…”

Section: Discussionmentioning

confidence: 99%

Don’t Let Its Name Fool You: Relapsing Thoracic Actinomycosis Caused by Pseudopropionibacterium propionicum (Formerly Propionibacterium propionicum)

et al. 2019

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Objective:Diagnostic/therapeutic accidents Background:Pseudopropionibacterium propionicum was called Propionibacterium propionicum until a recent taxonomy change in 2016. Diseases caused by P. propionicum resemble actinomycosis and thus differ dramatically from the infectious syndromes caused by common cutaneous Propionibacterium spp. However, if treating physicians are not familiar with P. propionicum and its clinical presentations, it is possible for them to regard it as a skin contaminant such as Cutibacterium acnes (formerly Propionibacterium acnes). Case Report:A 71-year-old man with past surgical history of right pneumonectomy was admitted with right chest wall abscess and right empyema. The chest wall abscess was drained surgically, and the empyema was drained via a chest tube. The abscess culture took 5 days to grow beaded branching Gram-positive rods, and 15 days to identify them as P. propionicum. The patient received 17 days of ceftriaxone and 4 weeks of doxycycline. However, he experienced a relapse of the chest wall abscess and right empyema 4 months after discontinuation of doxycycline. Cultures from the chest wall abscess and empyema grew P. propionicum again. We treated him with ceftriaxone for 6 months followed by minocycline for 7 months along with adequate drainage. Conclusions:It is important to recognize that P. propionicum can cause thoracic actinomycosis and will likely require the prolonged treatment course typical for actinomycotic disease, which is 2 to 8 weeks of intravenous antibiotic therapy followed by 6 to 12 months of oral antibiotic therapy.

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A case of thoracic actinomycosis presenting as sudden paraplegia

Cited by 3 publications

References 5 publications

Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing

Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing

Spinal Intrathecal Actinomycosis Causes Multisegmental Root Failure: A Case Report

Don’t Let Its Name Fool You: Relapsing Thoracic Actinomycosis Caused by Pseudopropionibacterium propionicum (Formerly Propionibacterium propionicum)

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