Empyema and lung abscess: An unusual presentation of pulmonary actinomycosis

Abstract

Actinomyces spp. are an infrequent cause of pulmonary infections. Actinomyces spp. comprise part of the normal flora of the oral cavity and gastrointestinal tract. A. meyeri is especially known for pulmonary involvement and disseminated disease. The authors present a case of a polymicrobial pulmonary abscess containing A. meyeri. The patient was a 58-year-old man with a history of coronary artery disease, alcohol abuse and hypertension. He presented with progressive dyspnea and cough productive of grey-colored foul smelling sputum. Upon admission, a chest computed tomographic (CT) scan revealed a right-lower-lobe lung abscess, with an associated loculated empyema. The following day, the patient underwent a thoracostomy with chest tube placement. The chest tube drained several hundred milliliters of purulent pleural fluid, but a follow up chest CT showed little change in the size of the underlying empyema. A subsequent thoracotomy with decortication was performed, which evacuated 100 mL of thick purulent fluid. Fourteen days after admission, the patient was discharged on a 6-to 12-week course of intravenous penicillin G, followed by a 6-month course of oral penicillin V.