Disseminated actinomycosis

A case of pulmonary actinomycosis with dissemination to skin, subcutaneous tissue, and bone is described. The cutaneous lesions were characterized by tender swellings and fluctuant nodules and were the presenting manifestation of the disease. Typical sulfur granules were present in the skin and pleural biopsies. Actinomyces israelii and its synergistic bacteria Actinobacillus actinomycetemcomitans were cultured from skin and pleura. Clinical improvement, with resolution of lung and disseminated skin lesions, was prompt with parenteral penicillin therapy.