Extensive actinomycosis with intracranial and mediastinal involvement: a therapeutic challenge

Area of Science:

• Neurology
• Infectious Diseases
• Medical Microbiology

Background:

• Actinomycosis is a rare bacterial infection, with central nervous system (CNS) involvement occurring in only 2%-3% of cases.
• CNS actinomycosis typically arises from a distant primary infection, spreading via the bloodstream (hematogenous route) or direct extension.
• Common presentations include brain abscess, meningoencephalitis, actinomycetoma, subdural empyema, and epidural abscess.

Observation:

• This report details an unusual case of extensive actinomycosis with intra- and extraparenchymal CNS, spinal canal, retropharyngeal, and mediastinal involvement.
• The widespread nature of the infection precluded complete surgical debulking due to the involvement of vital areas.
• The case presented significant management difficulties, including therapeutic resistance to conventional antibiotics and recurrent negative cultures.

Findings:

• The extensive and multifocal nature of the actinomycosis presented a complex diagnostic and therapeutic challenge.
• Treatment resistance to standard antibiotics complicated patient management.
• Repetitive negative cultures hindered definitive microbiological diagnosis and treatment guidance.

Implications:

• This case underscores the importance of considering actinomycosis in the differential diagnosis of complex CNS infections, especially with widespread disease.
• It highlights the challenges in managing extensive actinomycosis, particularly regarding surgical intervention and antibiotic therapy.
• Further research into optimal diagnostic and therapeutic strategies for extensive CNS actinomycosis is warranted.