Esophageal Actinomycoses Mimicking Malignancy

Area of Science:

• Medical Microbiology
• Gastroenterology
• Surgical Pathology

Background:

• Actinomycosis, an infection caused by anaerobic bacteria, typically presents in cervicofacial, thoracic, or abdominal regions.
• Esophageal involvement is exceptionally rare, posing diagnostic challenges due to its infrequent occurrence and potential to mimic other pathologies.

Observation:

• A 55-year-old woman presented with dysphagia and weight loss, symptoms suggestive of esophageal malignancy.
• Initial esophagogastroscopic biopsy yielded inconclusive results, showing only purulent material.
• Advanced imaging, including endoscopic ultrasonography and chest CT, indicated a lower esophageal mass with surrounding inflammation, further supporting a diagnosis of cancer.

Findings:

• Histopathological examination of the resected specimen confirmed distal esophageal actinomycosis, not malignancy.
• The infectious process presented as a mass lesion, successfully mimicking esophageal cancer on clinical and radiological assessments.

Implications:

• This case underscores the difficulty in preoperative diagnosis of esophageal actinomycosis.
• Clinicians must consider actinomycosis in the differential diagnosis of esophageal lesions, especially when malignancy is suspected but definitive evidence is lacking.
• Increased awareness of actinomycosis's rare esophageal manifestations is crucial for timely and accurate diagnosis, potentially avoiding unnecessary aggressive treatments.