Drastically progressive lung cavity lesion caused by Actinomyces odontolyticus in a patient undergoing chemoradiotherapy: A case report and literature review

Abstract

Pulmonary actinomycosis reportedly forms 15% of all cases of actinomycosis, and pulmonary Actinomyces odontolyticus is particularly rare. A 60-year-old man with a hoarse voice was referred to our hospital. Lung squamous cell carcinoma was diagnosed at the clinical tumor-node-metastasis stage of cT2N2M0, and concurrent chemoradiotherapy was initiated. Further, a small cavity was also detected in the left upper lobe, but it was observed. During chemoradiotherapy, the small cavity lesion rapidly increased accompanying infiltration, and administration of short-term antibiotics did not improve the patient's condition. Bronchoscopy did not show any diagnostic results. Although a rapidly progressive malignant lesion could not be excluded and surgical management was considered, resection could not be performed because of the tight adhesion of the mass. Therefore, bronchoscopy was performed again, and the bronchial lavage culture showed a positive smear for the Actinomyces species. Further, using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), the bacteria was identified as A. odontolyticus. After long-term administration of amoxicillin, the lung cavity with infiltration gradually improved. To the best of our knowledge, there have been nine cases of pulmonary A. odontolyticus (excluding those with only empyema or pleural mass without lung lesions), which can occur in immunocompetent patients with persistent lung shadow. None of the cases showed drastic deterioration; therefore, the present case is the first to highlight that A. odontolyticus possibly produce drastically progressive lung cavity lesion. Further, repeated bronchoscopy and MALDI-TOF MS could help to diagnose pulmonary actinomycosis.

Pulmonary actinomycosis and polymicrobial empyema in a patient with ABPA and bronchocoele

“…Twenty‐one cases of pulmonary actinomycosis caused by A . odontolyticus , 8–25 one case of empyema caused by L . rhamnosus 26 and 89 cases of empyema caused by S .…”

“…The findings of our literature review are summarized in Table 1. Twenty-one cases of pulmonary actinomycosis caused by A. odontolyticus, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] one case of empyema caused by L. rhamnosus 26 and 89 cases of empyema caused by S. mitis were identified. [27][28][29][30] Of these cases, 84 were identified as a part of a retrospective audit examining the aetiology of community-acquired lung abscesses diagnosed at one Japanese healthcare service.…”

Pulmonary Actinomycosis and Mucormycosis Coinfection in a Patient With Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia Undergoing Chemotherapy

“…Pulmonary actinomycosis gradually spreads with air-space consolidation, adjacent pleural thickening, or cavitation in the lung fields 1,2. Oral insanitation, diabetes, and frequent alcohol consumption are risk factors for pulmonary actinomycosis,5 whereas only few cases of pulmonary actinomycosis have been reported in immunocompromised patients undergoing chemotherapy or immunosuppressive therapy 6. On the other hand, mucormycosis occasionally occurs in immunocompromised patients and is often a progressive and fatal disease 7.…”

“…1,2 Oral insanitation, diabetes, and frequent alcohol consumption are risk factors for pulmonary actinomycosis, 5 whereas only few cases of pulmonary actinomycosis have been reported in immunocompromised patients undergoing chemotherapy or immunosuppressive therapy. 6 On the other hand, mucormycosis occasionally occurs in immunocompromised patients and is often a progressive and fatal disease. 7 For patients who need HSCT, mucormycosis must be treated before HSCT is performed.…”

Polymicrobial empyema; a novel case of Actinomyces turicensis

“…In addition to A. israelii , a review of nearly 500 clinical isolates of Actinomyces demonstrated the importance of A. meyeri, A. gravenitizii and A. odontolyticus as the primary Actinomyces sub-species isolated within the thoracic cavity to date [ 8 ]. These species have been associated with case reports of empyema, organizing pneumonia and cavitary lesions, respectively [ 9 , 10 , 11 ].…”