1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Adv Respir Med. 2021;89(5):532-537. doi: 10.5603/ARM.a2021.0071. Epub 2021 Jul 16.
Actinomycosis is a rare disease caused by Actinomyces spp. The clinical and radiological picture of the disease is uncharacter-istic, which delays the diagnosis and can lead to complications. We present a case of pulmonary actinomycosis complicated by a chest wall fistula in a 43-year-old man with advanced tooth decay. The patient was admitted to our Department due to a chest wall fistula with bloody discharge. A few months earlier, he was treated with antibiotics for pneumonia. Since then, weakness, exertional dyspnoea, and weight loss had been observed. On admission, increased inflammatory markers were found in laboratory tests. Chest computed tomography (CT) revealed right-sided encapsulated pleural fluid collection containing gas bubbles, pleural thickening, anterior thoracic wall soft tissues thickening and subcutaneous fat stranding. CT suggested an empyema or a breast either pleural malignancy. The picture suggested a breast or pleural tumour to differentiate with an empyema. Videothoracoscopy was performed, the histological examination of the collected samples revealed granulation tissue and bacterial colony of a morphology corresponding to Actinomyces spp. Pulmonary actinomycosis was diagnosed. Antibiotic therapy according to the guidelines was initiated and dental treatment was recommended. Healing of the fistula and significant regression of lesions in the right lung were achieved. Although it is a rare disease, actinomycosis should be considered in the differential diagnosis of any chronic infiltrative lung lesions.
放线菌病是一种由放线菌属引起的罕见疾病。该疾病的临床和影像学表现无特征性，这会导致诊断延误，并可能引发并发症。我们报告了一例 43 岁男性肺放线菌病并发胸壁瘘的病例，该患者有严重的龋齿。因胸壁瘘伴血性分泌物，该患者到我院就诊。几个月前，他因肺炎接受了抗生素治疗。此后，他出现了乏力、运动时呼吸困难和体重减轻。入院时，实验室检查发现炎症标志物升高。胸部计算机断层扫描（CT）显示右侧包裹性胸腔积液，其中含有气泡，胸腔增厚，前胸壁软组织增厚和皮下脂肪呈条索状。CT 提示脓胸或乳房恶性肿瘤。该影像提示需要与脓胸相鉴别是乳房或胸膜肿瘤。进行了胸腔镜检查，收集样本的组织学检查显示为肉芽组织和细菌菌落，形态与放线菌属相符。诊断为肺放线菌病。根据指南开始进行抗生素治疗，并建议进行牙齿治疗。瘘管愈合，右肺病变明显消退。尽管放线菌病是一种罕见疾病，但在鉴别诊断任何慢性浸润性肺部病变时都应考虑到放线菌病。
