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Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism.

B Møller-Jensen¹, S Kruse-Andersen, K Andersen

¹Department of Thoracic and Cardiovascular Surgery, Odense University Hospital, Denmark.

The Thoracic and Cardiovascular Surgeon

|October 1, 1988

Summary

This case study highlights a rare thoracic actinomycosis (a bacterial infection) that mimicked pulmonary embolism, delaying diagnosis. Direct microscopy was crucial for identifying the Actinomycetes infection.

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Area of Science:

Infectious Diseases
Pulmonology
Microbiology

Background:

Actinomycosis is a rare bacterial infection, often affecting the cervicofacial, thoracic, or abdominal regions.
Thoracic actinomycosis comprises about 15% of cases and can present with symptoms mimicking other serious conditions like lung cancer, abscess, or empyema.

Observation:

A 48-year-old woman presented with recurrent symptoms suggestive of pneumonia and pulmonary embolism over 2.5 years.
Initial investigations, including scintigraphy, indicated perfusion defects consistent with pulmonary embolism.
An axillary abscess eventually appeared, but initial pus cultures for Actinomycetes were negative.

Findings:

The patient's prolonged illness and misleading symptoms initially pointed towards pulmonary embolism.

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Diagnosis was significantly delayed due to the atypical presentation and negative initial microbiological cultures.

Definitive diagnosis was achieved through direct microscopy, revealing the presence of Actinomycetes.

Implications:

This case underscores the diagnostic challenges posed by thoracic actinomycosis due to its varied and often misleading clinical presentations.
Emphasizes the importance of considering actinomycosis in patients with persistent, unexplained thoracic symptoms, even with negative initial cultures.
Highlights the critical role of direct microscopy in diagnosing challenging cases of actinomycosis when standard culture methods fail.