Cutaneous Disseminated Actinomycosis in a Patient with Acute Lymphocytic Leukemia

Abstract

Actinomycosis is an uncommon infectious disease caused predominantly by Actinomyces israelii. The cutaneous disseminated form is usually caused by hematogenous dissemination from a primary extra-cutaneous lesion. We report here cutaneous disseminated actinomycosis without any detectable extra-cutaneous lesions in a 42-year-old Japanese woman with acute lymphocytic leukemia. Multiple soft nodules developed on her upper and lower extremities. Histopathological examination revealed "sulfur granules", which are a specific finding for actinomycosis. Cultures from biopsy specimens were not successful. There were no cervicofacial, thoracic, nor abdominal lesions. These findings suggest that cutaneous disseminated actinomycosis in our patient developed primarily in the skin. Although the patient was immunocompromised, antibiotic treatment with minocycline was effective.

Liver Abscess of Actinomyces israelii in a Hemodialysis Patient: Case Report and Review of the Literature

“…Immunosuppressive status is known as a risk factor of invasive actinomycosis (11)(12)(13)(14). It is also well known that patients receiving hemodialysis therapy due to ESRD had altered immune response.…”

Actinomycoses and Nocardia pulmonary infections

“…Occasional cases are reported in patients with HIV infection, acute leukaemia during chemotherapy, lung and renal transplantation or steroid use [15][16][17].…”

“…Because of its propensity for haematogenous dissemination, Nocardia often produces metastatic spread, most commonly to the brain (about 33% of all cases). Chest wall invasion may occur but is uncommon [15,[55][56][57].…”

Actinomyces viscosus causing disseminated disease in a patient on methotrexate

“…Methotrexate could be a reason for the dissemination as its use is associated with immunosuppression [12]. Disseminated actinomyces infection has been seen usually with A. israelii, A. meyeri, A. odontolyticus [4,6,8]. Most actinomycotic infections are polymicrobial and include other flora such as Actinobacillus, Fusobacterium, and Peptostreptococcus species [6].…”