Abstract
Presentation: A seven years old girl presented with a three-day history of cough and fever, and several weeks of back pain, anorexia and weight loss. Examination was significant only for a tender, non-erythematous swelling to the right mid-back measuring ten centimetres in length. Diagnosis and treatment: Investigations on admission included neutrophilia and elevated inflammatory markers. Chest radiograph demonstrated a confluent area of opacification within the right peripheral lower zone with a small pleural effusion. CT reported two large enhancing and infiltrative lesions in the right thorax and the right posterior lower ribs, and disseminated lymphadenopathy. Microbiology and histology of a tissue sample were conclusive for actinomycosis israelii. She had a full recovery following a nine month course of oral amoxicillin. Discussion: Invasive actinomycosis is rare, and a high clinical suspicion and thorough investigation is warranted with invasive pneumonia and atypical associated symptoms. Keywords: Actinomycosis; Pneumonia; Chest wall mass; non-accidental injury.
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