Periodontitis-associated septic pulmonary embolism caused by Actinomyces species identified by anaerobic culture of bronchoalveolar lavage fluid: a case report

Abstract

BackgroundPeriodontal disease is a less common but important cause of septic pulmonary embolism (SPE). However, the pathogens causing periodontal disease-associated SPE (PD-SPE) have been poorly understood. Actinomyces species are resident microbiota in the oral cavity. Here we report a case of PD-SPE caused by Actinomyces species, which was identified by anaerobic culture of bronchoalveolar lavage fluid (BAL).Case presentationA 64-year-old Asian man, complicated with severe chronic periodontitis, was admitted with chest pain and fever. Chest CT revealed multiple bilateral pulmonary nodules located subpleurally. We diagnosed the case as SPE associated with periodontitis. Although blood cultures were negative for the usual 5-day incubation, anaerobic culture of the BAL fluid sample yielded Actinomyces species. Antibacterial therapy alone did not ameliorate the symptoms; however, additional dental treatment, including tooth extraction, promptly did. The patient was discharged 23 days after admission. The 3-month follow-up revealed no recurrence of the symptoms and complete resolution of the lung lesions.ConclusionThis case demonstrated that Actinomyces species can cause PD-SPE. Additionally, clinicians should consider performing appropriate anaerobic culture of BAL fluid to identify the pathogen of SPE, and to ordering dental treatment, if necessary, in addition to antibiotics for the initial management of PD-SPE.

Saliva Microbiome Changes in Patients With Periodontitis With and Without Chronic Obstructive Pulmonary Disease

“…In a study by Endo et al a case of PD-SPE was identified by anaerobic culture of bronchoalveolar lavage fluid and the culprit was suspected to be Actinomyces species. The symptoms could not be treated with antibacterial therapy alone, and additional dental treatment was indicated (Endo et al, 2015).…”

A case report of primary sternal osteomyelitis caused by polymicrobial bacteria, including Actinomyces israelii

“…However, few cases of SPE caused by Actinomyces spp. have been reported [ 9 , 10 ]. We considered that the chest CT finding suggested SPE because the peripheral nodule showed feeding vessel signs and was a wedge-shaped peripheral lesion abutting the pleura [ 11 ].…”

“Holes” in the Jaw—A Report of Two Cases of Periapical Actinomycosis

“…The presented cases illustrate periapical actinomycotic osteomyelitis involving the jaw bones. Periapical actinomycosis is a distinct form of cervicofacial actinomycosis which may or may not be associated with the classic discharging ulcer/sinus at the angle of the jaw [ 2 , 6 ]. Our first patient could be considered immunocompetent while the second patient was clearly immunocompromised, given her history of refractory multiple myeloma and chronic steroid and pomalidomide use.…”

“…The infection can cross several tissue planes and mimic several other conditions, including malignancy [ 8 ]. By crossing tissue planes, the ensuing tissue destruction can result in devastating outcomes, including massive hemorrhage, secondary infection, increased intracranial pressure and septic emboli [ 6 ]. The predisposition to cervicofacial actinomycosis in relationship to poor dentition is not far-fetched given the established knowledge that Actinomyces are normal mouth flora [ 9 ].…”