Cervical Actinomycosis with Spinal Cord Compression

Abstract

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.

Actinomycosis masquerading as malignancy

“…This patient's lumbar puncture was difficult due to the mass lesion in that area, but CSF would normally show an elevated protein level and later a decreased glucose level in actinomycosis infection. 10 Actinomycosis is not commonly featured on lists of differential diagnoses for causes of cavitating pulmonary nodules, which was another contributing factor to the delay in diagnosis in this case. We propose that it should be widely acknowledged as a differential diagnosis of malignant metastases, including pulmonary secondaries.…”

Spinal Intrathecal Actinomycosis Causes Multisegmental Root Failure: A Case Report

“…Intravenous administration of high doses of penicillin G or amoxicillin for 4-8 weeks is preferred, and continued treatment of oral antibiotics for 6-12 months is usually recommended to prevent relapses and local complications (9,10). Nonetheless, the complete resolution of symptoms has been described in only 50% of the reported cases (17). Acceptable alternative regimens for intraspinal actinomycosis include tetracycline, erythromycin, and clindamycin (8).…”

Vertebral and Pulmonary Actinomycosis Mimicking Metastatic Lung Cancer

“…In a case report and literature review from 2001, Houman et al collected only 15 cases with spinal cord compression. 5 In the recent literature, seven more case reports are to be found 1,[6][7][8][9][10][11] . The case reported here is an extremely rare combination of spinal and thoracic involvement.…”