Esophageal Actinomycosis Presenting as an Obstructive Esophageal Mass

Abstract

Esophageal actinomycosis is a rare type of esophageal infection, with only approximately 24 cases previously reported in the United States. Most of these cases were described as erosions or ulcers when examined endoscopically. We present a 47-year-old woman who presented with dysphagia. Endoscopy showed a lower esophageal fungating mass, mimicking a malignant mass. Although there was a high suspicion of esophageal carcinoma, biopsy results showed esophageal actinomyces infection.

Esophageal Actinomycosis: A rare cause of dysphagia

“…number involved individuals who were immunocompetent. One trait, three of these cases share with our case is a history of diabetes [6][7][8]. Currently, the pathophysiology behind Actinomyces esophagitis remains unknown.…”

“…Esophagogastroduodenoscopy in this report identified severe Grade D esophagitis. However, other reports have also found Actinomyces esophagitis as a predisposing factor for the development of esophageal masses and strictures [7,10]. Due to the range of presenting morbidities, Actinomyces esophagitis mimics multiple pathologies including but not limited to, candida esophagitis and malignancy.…”

Esophageal Actinomycosis in an Immunocompetent Patient Mimicking Carcinoma: A Case Report

“…A case of esophageal actinomycosis masquerading as cancer was reported in a 46-year old woman presented on UGI endoscopy as an esophageal mass. 7 In another case of a 27-year-old male with features of esophagitis diagnosed as OA, UGI endoscopy showed an ulcerated lesion. 8 In our case, malignant looking ulceration was seen which is usually the more common presentation of esophageal actinomycosis on UGI endoscopy.…”

“…Actinomyces are isolated and identified only in a few cases as it is very difficult to culture this bacteria due to a variety of reasons like inadequate sampling, crosscontamination or prior antibiotic therapy. 7 So, microscopy plays a crucial role in diagnosis, which usually presents as necrotic tissue, fungal-like Gram-positive filamentous organisms and the characteristic yellowish coloured "sulphur granules". 3 Histopathological examination of the biopsy specimen in our case also showed the presence of Sulphur granules which guided us to the correct diagnosis.…”

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report

“…Esophageal actinomycosis does not usually involve the distal third of the esophagus due to its distance from the oropharynx, [11] but can present as chronic esophageal ulceration [12,13] or even mimicking esophageal carcinoma, [14][15][16][17] as in our case. Neurological dysphagia leading to aspiration constitutes a further risk factor that has been reported in some cases and is associated with distal esophageal compromise.…”