A Rare Case of Actinomyces israelii Presenting as Pericarditis in a 75-Year-Old Man

Abstract

Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.

Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature

“…Chest pain, dyspnea, fever, weight loss, and cough are very common manifestations of thoracic and pericardial involvement. 6,28 Examination of pericardial fluid may reveal a polymorphonuclear leukocyte predominance, but detection of sulfur granules and culture of the Actinomyces organism are very difficult 29 with only 26% of cultures being positive. 28 Different cut-off values for ADA activity, ranging from 30 to 60 U/l, have been suggested as being indicative of tuberculous pericarditis, 30 however high levels have also been found in another infectious conditions with purulent fluid.…”

“…34 For penicillin-allergic patients, doxycycline, minocycline, tetracycline, clindamycin, erythromycin, and cephalosporins have been proven to be effective in case reports. 29,[35][36][37][38] A recent in vitro study assessing the susceptibility of human clinical isolates of Actinomyces species to different antimicrobial agents showed that bacterial identification may be critical because of the resistance to some antibiotics. 33 Surgical treatment is controversial and may include incision and drainage of abscesses, resection of necrotic tissue, and curettage of bone.…”

Actinomyces and Related Organisms in Human Infections

“…A. meyeri was also implicated in splenic abscesses in a young girl with autoimmune hepatitis (108). In some abdominal actinomycosis cases arising from an abdominal source or even from the mouth, Actinomyces can result in pericarditis or the involvement of the liver; several Actinomyces species, particularly A. israelii (109)(110)(111)(112) and A. meyeri (92,113) but also A. funkei (114), A. odontolyticus (115), and A. turicensis (116), have been detected in liver abscesses. A. neuii has been detected in pericardial effusion samples of patients with chronic pericarditis (117).…”

Pericarditis caused by anaerobic bacteria

“…Makaryus et al [25] reported a patient with recent myocardial infarction and stent placement, atrial fibrillation and recent colonic perforation with subsequent colectomy/colostomy who presented with pericardial effusion and pericarditis due to A. israelii.…”