CERVICOFACIAL ACTINOMYCOSIS CAUSING PNEUMONIA AND EMPYEMA

Abstract

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Actinomyces are non-spore-forming, anaerobic bacteria with variable morphology found as part of normal oral flora. Active infections are seen in patients with a history of poor dental hygiene, diabetes, alcoholism, and immunosupression. Although actinomyces is a known cause of cervicofacial and lung infections separately, we present a case of a patient diagnosed with cervicofacial actinomycosis with extension into the pleural cavity causing empyema. CASE PRESENTATION: A 38 year old male with an only known history of alcohol abuse was admitted to the hospital for evaluation of an enlarging anterior neck mass. He stated that he had intermittent chills and night sweats. The patient was complaining of no shortness of breath or chest pain. Physical exam was unremarkable other than poor dentition, a large anterior neck mass, and decreased breath sounds in the right lung base. On presentation, the patient was febrile to 102.3F with a leukocytosis of 30,000 cells/mcL.The patient was initially started on broad spectrum antibiotics. CT of the chest showed posterior and medial right sided pleural thickening, dense consolidation of posterior and medial aspects of the right upper and lower lobes, likely right sided empyema with split pleura sign, and a 10cm by 6cm phlegmonous neck mass with likely extension into the apex of the right pleural cavity.There was associated mediastinal lymphadenopathy. The patient underwent surgical incision and drainage of the neck mass. Surgical pathology revealed granulation tissue with lymphohistiocytic infiltrate and focal abscess formation. Pathology also identified actinomyces species and sulfur granules. A chest tube was placed to drain the effusion and the patient's antibiotics were switched to ampicillin/sulbactam and eventually to oral penicillin. DISCUSSION: Actinomyces are non-spore-forming, strict or facultative anaerobes with a variable cellular morphology. They are only found in normal oral flora of humans and usually only cause infections in patient with poor dentician, diabetes, chronic alcoholism, and immunosupression. There is a male predominance. Disease is usually caused by direct, not hematogenous, spread and has the capability to cross fascial planes, form multiple abscesses, fistulae, and draining sinus tracts. Infections typical present in two forms as either slow indolent none painful infections or acute suppurative infection with significant pain and symptoms. Given that our patient was relatively asymptomatic, he most likely presented with the slow indolent form and had likely been infected for weeks before his neck mass was noted. CONCLUSIONS: Actinomyces infections are a well known cause of cervicofacial infections and can spread by direct extension. We present an unusually case of a patient with cervicofacial actinomycosis that formed a direct tract to the pleural cavity causing pneumonia and emypema. Reference #1: Moturi K, Kaila V. Cervicofacial Actinomycosis and its Management. Ann Maxillofac Surg . 2018;8(2):361-364. DISCLOSURES: No relevant relationships by Cory Bolinger, source=Web Response No relevant relationships by Jeffrey Williams, source=Web Response