Aggressive Thoracic Actinomycosis Complicated by Vertebral Osteomyelitis and Epidural Abscess Leading to Spinal Cord Compression

Yung, Babington C. K.; Cheng, James C. K.; Chan, Terrence; Loke, Tkl; Liu, John; Lau, P Y

doi:10.1097/00007632-200003150-00017

Cited by 30 publications

(16 citation statements)

References 10 publications

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“…The present case is the 15th. These cases are listed in Table 1 (3,6,7,9,12,13,17,19,23,24,25,26,27). In summary, they show that 9/15 (60%) were caused by A. israelii, the average age of the patients was 42.2 years, 12/14 (85.7%) cases occurred in males, and at least 8/12 (66.7%) cases were associated with thoracic involvement or other pulmonary symptoms.…”

Section: Discussionmentioning

confidence: 92%

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

et al. 2008

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Actinomyces spp. are considered rare pathogens in today's medicine, especially with thoracic vertebral involvement. Classic actinomycosis (50%) presents as an oral-cervicofacial ("lumpy jaw") infection. This report describes a case of spinal cord compression caused by Actinomyces israelii with the coisolation of Fusobacterium nucleatum. There are limited numbers of similar cases. CASE REPORTThe case described here involves a 43-year-old Filipino man who presented to a medical center emergency department with a chief complaint of acute lower back pain and urinary incontinence. He had been in his usual state of health until approximately 3 days prior to admission, when he first noticed a gradual onset of bilateral lower-extremity weakness, followed by difficulty with walking and, finally, the inability to arise from bed. In addition, the patient stated that he had been experiencing low-grade fevers and progressive weight loss over the past several months. His medical history was unremarkable and did not include any recent trauma. The patient had emigrated from the Philippines to Hawaii about 20 years earlier. However, he denied any history of exposure to tuberculosis or any recent travel back to the Philippines or Southeast Asia.In the emergency room, the patient appeared to be disoriented, although he was able to follow simple commands. His vital signs included a temperature of 97.8°F, blood pressure of 121/75 mm Hg, a heart rate of 116 beats/min, and mild tachypnea, with an O 2 saturation of 99% on room air. On physical examination, he was noted to have poor dentition and evidence of multiple previous dental extractions. A neurological examination revealed significant bilateral lower-extremity weakness (two of five) with brisk deep-tendon reflexes, positive ankle clonus, and a positive Babinski sign, as well as diminished rectal tone. The remainder of the physical examination was unremarkable. Laboratory blood findings were significant for leukocytosis (22.0 ϫ 10 9 /liter) with 87% segmented neutrophils, an elevated platelet count of 722 ϫ 10 6 /liter, and an erythrocyte sedimentation rate of 84 mm/h. A screen for human immunodeficiency virus type 1 and 2 antibodies was negative. The remaining laboratory findings were noncontributory.A chest X ray showed a left-lower-lobe infiltrate with minimal pleural effusion.Because of the possibility of spinal cord compression and injury, the patient was admitted to the medical intensive care unit for further workup and management. This included magnetic resonance imaging of the spine, which showed an abnormal signal intensity involving the thoracic vertebrae from T5 through T8 and an abnormal soft tissue mass enhancement consistent with an apparent abscess that involved the left posterior chest wall and ribs and that extended to the thoracic vertebral column and into the epidural space, with apparent spinal cord compression. A computed tomography scan of the chest revealed similar abnormal findings involving the left posterior chest wall and ribs as well as a collapsed lef...

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Section: Discussionmentioning

confidence: 92%

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

et al. 2008

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“…CT may be useful in demonstrating thoracic wall involvement, bone destruction, presence of osteomyelitis and pleural alterations. Invasion to mediastinum, retroperitoneum and compromising of soft tissues usually associated with fistulas and fibrosis are also radiological findings suggestive of thoracic actinomycosis that may be demonstrated by MRI [13,[16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Thoracic actinomycosis: report of a patient with advanced-stage disease

Santos¹,

Zambenedetti²,

Mann³

et al. 2007

Braz J Infect Dis

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The authors describe a case of advanced thoracic actinomycosis. A 44-year-old man with previous episodes of productive cough with purulent sputum, fever, chest pain and subcutaneous nodules on the left hemithorax was admitted with complaints of lumbar pain irradiating into left lower limb and presence of mass lesion on the left lumbar region. Imaging evaluations were obtained and the patient underwent left lower lobectomy. Histopathology, microscopic examination and anaerobic culture of the resected material diagnosed thoracic actinomycosis.

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“…In the early period of this disease, the glucose content in the cerebrospinal fluid may not decrease. With the increasing release of glycolytic enzyme into the cerebrospinal fluid by the Actinomyces , which are anaerobic-to-microaerophilic bacteria [1][2][3][4][5] , a great deal of glucose is zymohydrolyzed into lactic and pyroracemic acid, with the result of decreased content of glucose. Meanwhile, because the Actinomyces can change the metabolism of the nervous system and the subsequent metabolite can inhibit the carrying and transporting capability of the membrane of the blood-brain barrier, less blood glucose can enter the cerebrospinal fluid, which can also result in the decrease in glucose level in the cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

“…Actinomycosis is a subacute-to-chronic bacterial infection caused by filamentous, Gram-positive, anaerobic-tomicroaerophilic bacteria that are normal flora of the oral cavity, lower gastrointestinal tract and female genital tract [1][2][3][4][5] . It is characterized by contiguous spread, suppurative and granulomatous inflammatory reaction, and formation of multiple abscesses and sinus tracts that discharge sulfur granules.…”

Section: Introductionmentioning

confidence: 99%

Cervical Actinomycosis with Spinal Cord Compression

Gao

et al. 2007

Chemotherapy

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Cervical actinomycosis with spinal cord compression is extremely rare. The clinical presentation of spinal actinomycosis may be nonspecific and back pain is the most consistent early symptom. Here, we present such a case with fever, pain in the neck and upper back, progressive weakness and numbness in all 4 limbs with difficulty ambulating, constipation and uroschesis. Correct diagnosis is difficult because the clinical and radiological findings of actinomycosis closely resemble metastatic tumors and other infectious processes. Timely surgical debridement and decompression contributed to the prompt improvement of the patient’s conditions, and histopathological demonstration of the inflammatory granulation tissue and Gram-positive sulfur-containing filamentous bacteria led to the correct diagnosis of actinomycosis. The diagnosis must be made promptly because delayed treatment can result in irreversible neurologic damage or death. Timely and long-term antibacterial therapy is essential for the complete recovery of the patient with actinomycosis.

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Aggressive Thoracic Actinomycosis Complicated by Vertebral Osteomyelitis and Epidural Abscess Leading to Spinal Cord Compression

Abstract: High clinical suspicion and proper use of imaging data led to timely diagnosis of this rare case of mediastinal, epidural, and intramuscular thoracic actinomycosis. Specific antibiotic therapy and timely, well-targeted surgical intervention greatly improve the outcome of this condition.

Cited by 30 publications

References 10 publications

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

Thoracic actinomycosis: report of a patient with advanced-stage disease

Cervical Actinomycosis with Spinal Cord Compression

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