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Concurrent Hepatic Abscess and Pleural Empyema due to Actinomyces odontolyticus After Recent COVID-19 Infection: A
Dimo Dimitrov1,2, Jad Mitri1,2, Hind El Naamani1,2
1Department of Medicine, Boston Medical Center-Brighton, Boston, Massachusetts, USA.
Introduction:
Actinomycosis is a rare, slow-progressing infection mimicking malignancies by penetrating mucosal barriers and spreading across anatomical planes. While typically affecting the cervicofacial area, it can also involve the thorax and abdomen, with simultaneous hepatic and pulmonary involvement being particularly rare.
Case Description:
We report the case of an 85-year-old woman with chronic kidney disease, diabetes, and multiple dental procedures who developed fever, myalgias, and abdominal pain a few weeks after recovering from COVID-19. Diagnostic workup revealed a liver abscess extending into the right perinephric space and a small pleural effusion. Gram stain of abscess aspirate showed Gram-positive, branching filamentous rods, negative on a modified AFB stain. Cultures grew Actinomyces odontolyticus, differing from the more common A. israelii. Her hospital course was complicated by acute hypoxic respiratory failure, with CT showing an expanded, loculated right pleural effusion. Treatment included prolonged antibiotic therapy and interventional radiology procedures for abscess drainage.
Discussion:
This case highlights the diagnostic and therapeutic challenges of hepatic actinomycosis caused by A. odontolyticus, particularly when affecting adjacent structures, such as the diaphragm and lung. The infection may have spread hematogenously to the liver with subsequent transdiaphragmatic extension into the thoracic cavity or, alternatively, may have originated from aspiration-related thoracic infection with secondary extension toward the liver. Typically occurring in immunocompetent individuals, this severe presentation may reflect the combined influence of recent COVID-19 infection, chronic comorbidities, and recent dental procedures. This underscores the need for vigilance in recognizing atypical postviral infections and highlights the need for further research into opportunistic bacterial infections following COVID-19-related immune dysregulation.
Insights
This case study details a rare instance of hepatic actinomycosis caused by Actinomyces odontolyticus in an elderly woman post-COVID-19. The infection spread to the lung, presenting diagnostic and treatment challenges.
Area of Science:
- Infectious Diseases
- Medical Case Reports
- Bacteriology
Background:
- Actinomycosis is a rare, chronic bacterial infection often mimicking malignancy.
- It typically affects the cervicofacial region but can involve the thorax and abdomen.
- Simultaneous hepatic and pulmonary actinomycosis is exceptionally uncommon.
Purpose of the Study:
- To report a unique case of hepatic actinomycosis caused by Actinomyces odontolyticus.
- To highlight the diagnostic and therapeutic challenges associated with this rare presentation.
- To explore potential contributing factors, including recent COVID-19 infection and comorbidities.
Main Methods:
- Case report of an 85-year-old female with chronic kidney disease and diabetes.
- Diagnostic workup included imaging (CT) and Gram stain/cultures of liver abscess aspirate.
- Treatment involved prolonged antibiotics and interventional radiology for abscess drainage.
Main Results:
- The patient presented with a liver abscess extending to the perinephric space and pleural effusion.
- Cultures identified Actinomyces odontolyticus, a less common pathogen.
- Hospital course was complicated by acute hypoxic respiratory failure requiring intervention.
Conclusions:
- Hepatic actinomycosis by A. odontolyticus poses significant diagnostic and therapeutic challenges, especially with thoracic involvement.
- Recent COVID-19, comorbidities, and dental procedures may have predisposed the patient to this severe opportunistic infection.
- Further research is needed on post-COVID-19 opportunistic infections and immune dysregulation.
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