Esophageal Actinomycosis: A Case Report and Review of the Literature

Abstract

A 37-year-old African-American male with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. An upper gastrointestinal endoscopy had been performed two months previously and esophageal biopsy revealed extensive candidal infection with ulceration. He temporarily responded to fluconazole. Repeat biopsy revealed actinomyces and continued candidal infection. Review of the original biopsy also demonstrated actinomyces in addition to candida. After initial response to therapy with penicillin, he worsened on outpatient therapy and subsequently expired from progression of disease. Lack of compliance may have been contributary. To date, 8 patients with esophageal actinomycosis have been reported, five of whom had AIDS. Of the remaining three, none was otherwise immunocompromised. This is the first report of esophageal actinomycosis occurring as a superinfection of candidal ulceration. We also describe the findings and utility of thoracic CT in this condition and review the literature.

Actinomycosis Mimicking Anastomotic Recurrent Esophageal Cancer on PET-CT

“…1 Mucosal disruption may lead to infection at virtually any site of the body. Actinomycosis is an indolent, slow-growing, progressive infection caused by anaerobic or microaerobic Gram-positive bacilli, primarily of the genus Actinomyces, which colonize the mouth, colon, and vagina.…”

Actinomycotic infection of the oesophagus

“…[6][7][8][9][10][11][12][13][14][15] Six patients, including the present case, had documented malignancy, 6-10 but only one had oesophageal cancer. 6 Two patients including the current case were receiving chemotherapy, 6 and only one patient was receiving immunosuppressive therapy.…”

Esophageal Actinomycosis, A Rare Complication After Self-Expanding Metallic Stent Deployment

“…2 Definitive diagnosis with positive cultures requires 5 to 7 days but is seen in only a minority of cases. 5 Barium oesophagogram may demonstrate deep ulcers with fistulas and multiple sinus tracts. CT may demonstrate a thickened oesophageal wall in early stages with or without sinus tracts.…”