Primary actinomycosis of the right upper extremity - an unusual presentation

S Pratibha ,Bengaluru Orthopedics ,S Arundhathi ,K S Lakshmi ,Raj Kumar

doi:10.17511/jopm.2018.i01.10

Abstract

Actinomycosis is a chronic disease characterized by multiple abscesses, granulomas, tissue destruction, extensive fibrosis and formation of sinuses. We report a case of 45 year old female with primary cutaneous actinomycosis of right upper extremity, which is a very rare site of occurrence. The patient was treated successfully with extended period antimicrobial treatment with Doxycycline (spacing) and Cefixime.

Highlights

Actinomycosis is a chronic disease characterized by multiple abscesses, granulomas, tissue destruction, extensive fibrosis and formation of sinuses
With this we confirmed it as primary actinomycosis of right upper extremity
Actinomycosis is a rare infection primarily caused by Gram positive, non-spore forming, and anaerobic bacillus of Actinomyces species

Summary

Introduction

Actinomycosis is a chronic disease characterized by multiple abscesses, granulomas, tissue destruction, extensive fibrosis and formation of sinuses. Primary actinomycosis of an extremity is very uncommon with less than 50 case reports in the literature[1] It can occur by secondary involvement through direct extension or hematogenous spread. Patient wasafebrileand her systemic examination was within normal limits.Local examination revealed multiple discharging sinuses over right arm and forearm with a fewpuckered scars (fig 1a & 1b). Fig-2.: Actinomycotic colonies with Splendore- Hoeppliphenomenon (H &E, 40X) Gram stain done on section from paraffin block revealed many pus cells with a few Gram positive filamentous bacilli with club shaped structures suggestive of Actinomycosis (Actinomycetoma of right hand)[fig 3]. Culture of pus from discharging sinuses yielded scanty growth of spidery colonies after 72 hrs but colonies failed to survive on further incubation anaerobically With this we confirmed it as primary actinomycosis of right upper extremity. The patient responded well to treatment and the sinuses healed with scars [fig 4a & 4b]

Discussion

Findings

Conclusion