An unusual cause of thoracic mass.

Wilson, DC; Redmond, A.O.B.

doi:10.1136/adc.65.9.991

Cited by 16 publications

(11 citation statements)

References 5 publications

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“…Intrathoracic or abdominal disease is rare [24, 26–31]. Cervicofacial infection may follow any injury to the oral mucosa, even the simple eruption of a tooth [22], and characteristically spreads by direct invasion of adjacent tissues.…”

Section: Discussionmentioning

confidence: 99%

Actinomyces in Chronic Granulomatous Disease: An Emerging and Unanticipated Pathogen

Reichenbach¹,

Lopatin²,

Mahlaoui³

et al. 2009

CLIN INFECT DIS

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Background Chronic granulomatous disease (CGD) is a rare inherited disease of the phagocyte NADPH oxidase system that causes defective production of toxic oxygen metabolites, impaired bacterial and fungal killing, and recurrent life-threatening infections, mostly by catalase-producing organisms. We report for the first time, to our knowledge, chronic infections with Actinomyces species in 10 patients with CGD. Actinomycosis is a chronic granulomatous condition that commonly manifests as cervicofacial, pulmonary, or abdominal disease, caused by slowly progressive infection with oral and gastrointestinal commensal Actinomyces species. Treatment of actinomycosis is usually simple in immunocompetent individuals, requiring long-term, high-dose intravenous penicillin, but is more complicated in those with CGD because of delayed diagnosis and an increased risk of chronic invasive or debilitating disease. Methods Actinomyces was identified by culture, staining, 16S ribosomal DNA polymerase chain reaction, and/ or a complement fixation test in 10 patients with CGD. Results All 10 patients presented with a history of fever and elevated inflammatory signs without evident focus. Diagnosis was delayed and clinical course severe and protracted despite high-dose intravenous antibiotic therapy and/or surgery. These results suggest an unrecognized and unanticipated susceptibility to weakly pathogenic Actinomyces species in patients with CGD because these are catalase-negative organisms previously thought to be nonpathogenic in CGD. Conclusions Actinomycosis should be vigorously sought and promptly treated in patients with CGD presenting with uncommon and prolonged clinical signs of infection. Actinomycosis is a catalase-negative infection important to consider in CGD.

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Section: Discussionmentioning

confidence: 99%

Actinomyces in Chronic Granulomatous Disease: An Emerging and Unanticipated Pathogen

Reichenbach¹,

Lopatin²,

Mahlaoui³

et al. 2009

CLIN INFECT DIS

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“…1 The 3 major forms are cervicofacial (65%), thoracic (15%), and abdominal (20%). 4 Cervicofacial disease is from infection of the teeth and gingiva; abdominal disease may be from perforation of the appendix or cecum. 1 Pulmonary actinomycosis occurs from aspiration of infected material from the oral cavity or carriage into the lung by a foreign body, hematogenous seeding, or spread ofcervicofacialorabdominalinfectionthroughtissueplanes.…”

Section: Denouement and Discussionmentioning

confidence: 99%

Radiological Case of the Month

Jameel

Wadowski²,

Orentlicher³

et al. 2001

Arch Pediatr Adolesc Med

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14-YEAR-OLD girl had severe, sharp midback pain for 3 weeks and nontender, gradually enlarging left chest wall swelling for 2 weeks. It was unrelieved by change of position. One month before symptoms started, she had fallen, striking her left chest. No bruise remained and the tenderness subsided; however, 2 weeks later, swelling began in the area of injury. She had lost 10 pounds over the last 2 months while dieting. She had no fever, cough, chills, sweats, joint pain, or rash. Last year, she lost a filling from a right upper molar, but otherwise, her last dental care was 6 years ago. She was receiving 325 mg of ferrous sulfate per day for iron deficiency anemia diagnosed 1 month earlier. Findings from physical examination revealed an obese female (height, 139.7 cm; weight, 83.3 kg). Her temperature was 38.5°C; pulse, 120 beats per minute; respirations, 20 breaths per minute; and blood pressure, 122/88 mm Hg. Spinal examination showed scoliosis but no vertebral or costal tenderness. A 4-cm mass was palpated over the left rib cage at the anterior axillary line in the 10th interspace. This mass was ovoid, nontender, soft, and cool to the touch without erythema. A large cavity was present in the upper left molar.

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“…5 Although it is not an opportunistic infectious disease, it has been associated with the use of corticosteroids, leukemia and children with congenital immunodeficiencies and HIV infection. The 3 major forms of actinomycosis are cervicofacial (65%), thoracic (15%) and abdominal/pelvic (20%) 6 . A severe form of periodontitis may be associated with actinomyces.…”

Section: Review Of Literaturementioning

confidence: 99%