Esophageal Actinomycosis Research Articles

An Uncommon Presentation of Esophageal Actinomycosis in a Patient with Recent Kidney Transplant

An Uncommon Presentation of Esophageal Actinomycosis in a Patient with Recent Kidney Transplant

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report

BackgroundActinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown.Case presentationA 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma.ConclusionEsophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

S2292 Dysphagia and Esophageal Mass: Cancer or Actinomycosis?

Introduction: Esophageal actinomycosis is a rare type of esophageal infection and presents as erosions or ulcers under endoscopy. Here we present a 63-year-old woman who complains of dysphagia, with biopsy showing actinomyces infection but repeat biopsy revealed squamous cell carcinoma. Case Description/Methods: A 63-year-old Chinese female with a history of gastritis presented with solid food dysphagia and epigastric pain for over a month. The pain was not improved after proton pump inhibitors but was relieved by self-induced vomiting. Review of systems showed 10lb weight loss over a month with a recent history of self-resolved hematemesis. Prior esophagogastroduodenoscopy (EGD) and colonoscopy were normal 3 years ago. CT of the chest demonstrated a 1.7 cm circumferential mass in the mid-esophagus with luminal narrowing (Figure 1A). EGD discovered a friable soft circumferential mass 26-29 cm from the incisors that are not actively bleeding but covered with blood clots (Figure 1B). Biopsy showed esophageal mucosal ulceration and actinomyces infection. The patient was started on amoxicillin to treat actinomyces infection. Meanwhile, the patient underwent a repeat EGD for rebiopsy given concerns for malignancy, which resulted in poorly differentiated squamous cell carcinoma. Endoscopic ultrasonography (EUS) was performed for staging but was limited staged uT3N1Mx as the mass could not be traversed by echoendoscopy (Figure 1C). Later PET-CT illustrated locally advanced disease with atrium involvement (Figure 1D). The patient underwent neoadjuvant chemotherapy with carboplatin-taxol and radiation followed by esophagogastrectomy for curative intent. Discussion: Actinomyces are facultatively anaerobic, Gram-negative bacilli. They commensally live within the oral cavity and gastrointestinal tract. Most esophageal actinomyces (EA) infection was previously described to resemble esophagitis or esophageal ulcers, with the endoscopic description being extensive necrotic areas. EA typically presents with dysphagia and odynophagia, particularly in immunocompromised patients or with malignancies. Actinomyces species capitalize on tissue injury or mucosal breach to invade adjacent structures and spreads regardless of anatomical barrier, thus mimicking malignancy. In our case, the local tissue damage caused by neoplastic disease or irradiation predisposed the actinomyces infection. Clinicians need to have a high index of suspicion and clinical knowledge regarding its unusual presentations and ability to mimic malignancy.Figure 1.: A. CT of the chest demonstrated a 1.7 cm mass present in the mid-esophagus with lumen narrowing. B. A friable mass without active bleeding but covered with blood clots on endoscopy finding. C. Limited staged uT3N1Mx under EUS D. PET-CT showed locally advanced disease with atrium involvement.

S1915 Esophageal Actinomycosis Presenting as Persistent Dysphagia in an Immunocompromised Host

INTRODUCTION: Actinomyces are a Gram-positive anaerobic bacterium part of the normal flora of the human oropharyngeal, gastrointestinal and genitourinary tract. Infectious esophagitis caused by actinomyces is rare, with less than 30 cases reported in the English literature. Majority of cases involve immunocompromised patients and those with prior esophageal injury. Herein, we describe a case of a 50-year-old immunocompromised male who presented with complaints of dysphagia and was diagnosed with esophageal actinomycosis through biopsy of suspected lesions. CASE DESCRIPTION/METHODS: A 54 y.o male with a PMH of HIV and DMII presented with dysphagia and odynophagia. He had a recent candidal esophagitis. Patient was compliant with his antiretroviral therapy and had a low HIV viral load. EGD was done and showed a submucosal mass in the lower third of the esophagus (Figure 1). Biopsy showed chronic granulomatous inflammation and micro-abscesses. Culture grew Actinomyces. He was initially treated with PO Cefdinir for 4 weeks without resolution of symptoms, then started on Augmentin, again without any relief. Consensus was to treat with an eight-week course of ertapenem IV. Unfortunately, there was no improvement. Patient was admitted and started on iv Penicillin G. Within 5 days there was marked improvement of his symptoms. He was discharged home on PO penicillin 500mg BID with initial good response. Unfortunately, he has continued to experience intermittent nausea, vomiting, and dysphagia as of this writing. DISCUSSION: Actinomycosis often happens after surgery, trauma, instrumentation or inflammatory processes. Co-infections with Actinobacillus, Eikenella, Fusobacterium and Candida is common. It can mimic malignancy, tuberculosis, or other more common disorders. Thoracic actinomycosis accounts only for 15% of all cases and esophageal infection is rare. Esophagitis, esophageal ulcerations, abscesses, fistulas, sinus tracts and strictures have been described. Around 75% of cases occur in immunocompromised hosts. Dysphagia and odynophagia are the most common complaints. Radiologic findings are nonspecific and EGD with biopsy is always needed. Isolation of the bacteria occurs in a minority of cases but it is the gold standard for diagnosis. Management consists of IV Penicillin followed by oral Penicillin for 6–12 months. Actinomyces remain highly sensitive to Penicillin however if allergy is present, tetracyclines, clindamycin, and macrolides are alternative options. In some cases, surgical drainage may be required.Figure 1.: Non obstructing mass on the lower third of the Esophagus.

1814 Esophageal Actinomycetoma Masquerading as Cancer in an Immunocompetent Patient

INTRODUCTION: All that looks like cancer is not always cancer. Esophageal Actinomycosis is a fine example that frequently mimics malignancy. Actinomyces is a bacteria acting like fungi which extremely rarely infects the esophagus in immunocompetent hosts. Risk factors are unknown due to paucity of data. CASE DESCRIPTION/METHODS: A 79-year-old African American woman was admitted with mild hematemesis. She had progressive, painless dysphagia for solids for 6 weeks and had lost 12 lb. She had curative lobectomy for lung cancer and quit smoking 10 years ago. She had COPD and GERD. Medications included Budesonide-Formoterol and Albuterol inhalers. She had no history of chemo/radiotherapy, tuberculosis, HIV, or diabetes. Physical exam was normal. CBC, renal function and LFTs were normal. CT chest with contrast showed air-fluid levels within the esophagus and wall thickening. EGD revealed a 1 cm friable mass in distal esophagus. Biopsy confirmed actinomycosis and candida esophagitis. She was discharged on Ceftriaxone 2 g/day for 4 weeks and oral Fluconazole 200 mg/day for 3 weeks. At 1-month follow up, dysphagia had improved and she was switched to oral Amoxicillin for 6 months. DISCUSSION: Actinomyces is an anaerobic, gram-positive, filamentous, branching rod. It grows as normal flora in the mouth and GI tract. Esophageal Actinomycosis is exceedingly rare in immunocompetent people with only 28 cases indexed in PubMed in English. 13 cases were reported in the US. 2/3 of patients were immunocompromised. It invades the esophagus following mucosal breach, and presents as a mass, esophagitis, ulcer, abscess, fistula, or stricture causing dysphagia/odynophagia. It is a great imitator, often misleading physicians, thereby triggering malignancy work-up. Diagnosis involves imaging and biopsy. Microscopy reveals yellow sulfur granules in 50% of cases. Actinomyces is difficult to isolate with culture yield as low as 24%. RNA sequencing can provide a quick, accurate diagnosis in future. Patient education and counseling is the cornerstone of successful prolonged antibiotic therapy. An initial course of IV penicillin G or Ceftriaxone for 4-6 weeks is followed by oral penicillin V or amoxicillin for 6-12 months. Necrotic ulcer, fistula, or abscess is managed surgically. We believe that inhaled corticosteroids may have created the milieu for the growth of Actinomyces and Candida in the esophagus by impairing local defenses. 43% of inhaled corticosteroid is deposited in the esophagus according to Gamma scintigraphic studies.

1730 Esophageal Actinomycosis in a Patient With Long-Standing Esophageal Stent

INTRODUCTION: Actinomyces is a commensal in aero-digestive tracts which rarely causes infection. The commonest site is cervicofacial region. Risk factors are low immunity and pre-existing tissue damage. Esophageal involvement is rare. We report a case of esophageal actinomycosis in an immunocompetent patient. CASE DESCRIPTION/METHODS: A 71-year-old male presented with recurrent dysphagia. The patient had multiple prior EGDs for management of refractory peptic stricture due to gastrin secreting pancreatic neuroendocrine tumor. He undewent multiple prior procedures with placement of fully-covered self-expanding metal stents (SEMS) for therapy of refractory stricture, as surgical esophagectomy was not possible due to co-morbidities and patient preference. On previous EGD, one of the stents could not be removed due to tissue ingrowth at the distal end, and another SEMS was placed overlapping the imbedded stent and extending to the gastric cardia. The patient was lost to follow up for 7 months until presenting with recurrence of dysphagia. EGD now showed proximal migration of the distal stent with severe stenosis, inflammation, and nodularity distal to the esophageal stents. The distal stent was imbedded in the abnormal mucosa and could not be removed. Following balloon dilation another SEMS was placed in the distal esophagus. Pathology revealed ulcerated acute esophagitis with actinomycetes colonies. The patient was placed on a long course of IV penicillin-G. At subsequent EGD a month later, the tissue ingrowth improved allowing removal of the esophageal stents. Repeat biopsies did not reveal actinomyces. DISCUSSION: Actinomyces, a gram positive anaerobic rod, is unable to penetrate healthy tissue. It requires mucosal compromise to invade tissue, leading to abscess and sinus formation across tissue planes. Our patient had multiple risk factors - mucosal damage, endoscopic dilations and stenting. Esophageal stent in situ for longer than 3 months increases the risk of embedment. Discovery of esophageal ulceration or tissue ingrowth in this setting should raise suspicion for possible actinomycosis (among other diagnoses) and biopsies should be obtained. Gram stain and histology would reveal necrosis with yellow sulfur granules and gram-positive filamentous pathogen. Early diagnosis is necessary to initiate treatment in a timely manner to prevent the potentially debilitating sequelae of chronic infection. Treatment includes penicillin G or amoxicillin for 3-12 months.

ESOPHAGEAL ACTINOMYCOSIS IN RECIPIENT AFTER HEART TRANSPLANTATION

In this article, we reported a clinical case of late posttransplant complication – esophageal actinomycosis in 58-yr-old woman 8 months after heart transplantation. Recipient had presented with a complaint of dyspeptic phenomena. Patient’s examination did not show any features. Blood results were fine but tacrolimus concentration was increased (24 ng/ml). Esophagogastroduodenoscopy identified signs of esophageal candidiasis, biopsy was taken. Histological examination revealed esophageal actinomycosis. According to other investigations we did not find any signs of antinomycosis in other organs. Taking into account the results of obtained research, there was no evidence of deep tissue invasion and no indications for surgical treatment, conservative management was chosen. Three months of antibacterial treatment (Doxycycline) was effective. Considering long-term management of this complication in out-patient department it is important to accomplish strictly the protocol of posttransplant follow-up, the same as it allows to diagnose in time. Conservative management of esophageal actinomycosis diagnosed on early stage can be effective.

Esophageal Actinomycosis, A Rare Complication After Self-Expanding Metallic Stent Deployment

Esophageal Actinomycosis, A Rare Complication After Self-Expanding Metallic Stent Deployment

Tu1321 - A Rare Case of Esophageal Actinomycosis in an Immunocompetent Host

Tu1321 - A Rare Case of Esophageal Actinomycosis in an Immunocompetent Host

Dysphagia Caused by Esophageal Actinomycosis

Dysphagia Caused by Esophageal Actinomycosis

Esophageal actinomycosis in a patient with end‐stage renal disease

Actinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal disease patient. A 28-year-old lady, known case of systemic lupus erythematosus, hepatitis B virus infection with end-stage renal disease on regular maintenance hemodialysis since 5 years presented with history of epigastric pain and odynophagia for 1 week. Her upper gastrointestinal endoscopic examination revealed extensive necrotic areas with membrane in the esophagus. Histopathology revealed actinomycotic colonies and bacterial clumps. She was treated with intravenous penicillin followed by oral ampicillin for 6 months. She showed marked clinical improvement, and repeat endoscopy showed healing of ulceration and no evidence of actinomycosis.

A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient

A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient

A rare presentation of esophageal actinomycosis in an immunocompetent patient

A rare presentation of esophageal actinomycosis in an immunocompetent patient

A Case of Esophageal Actinomycosis in a Patient with Normal Immunity

Actinomycosis is a chronic suppurative disease and caused by Actinomycosis species, principally Actinomyces israelii, which are part of the normal inhabitant on the mucous membrane of the oropharynx, gastrointestinal tract, and urogenital tract. It usually affects cervicofacial, thoracic and abdominal tissue. Cervicofacial type has the highest percentage of occurrence with 50%. Actinomycosis frequently occurs following dental extraction, jaw surgery, chronic infection or poor oral hygiene. It may also be considered as an opportunistic infection in immunocompromised patients such as malignancy, human immunodeficiency virus infection, diabetes mellitus, steroid usage or alcoholism. But, actinomycosis rarely occurs in adults with normal immunity and rare in the esophagus. We report an unusual case of esophageal actinomycosis which was developed in a patient with normal immunity and improved by therapy with intravenous penicillin G followed oral amoxicillin, and we also reviewed the associated literature.

A Case of Esophageal Actinomycosis in a Patient with Diabetes Mellitus

A 47-year-old patient with diabetes mellitus was admitted with the complaints of sore throat and dysphagia. We performed an esophagogastroduodenoscopy and found esophageal ulcers. Histological examination of the esophageal biopsy revealed sulphur granules, and immunological findings ruled out viral infection. Thus, we diagnosed an isolated actinomycotic infection of the esophagus and treated the infection with oral amoxicillin. This case illustrates that actinomycotic infection of the esophagus can occur in immunocompetent patients. Therefore, when evaluating dysphagia, the probability of actinomycotic infection must be considered not only in immunocompromised patients, but in immunocompetent individualswith diabetes mellitus. (Korean J Med 2012;82:580-584)

A rare cause of esophageal strictures: Actinomyces

Infectious esophagitis is associated with considerable morbidity and mortality. 1 Goff J.S. Infectious causes of esophagitis. Annu Rev Med. 1988; 39: 163-169 Crossref PubMed Scopus (25) Google Scholar Bacteria are often looked at as colonizing organisms rather than true pathogens. Esophageal actinomycosis is a rarely described entity that, if undiagnosed, can lead to serious complications. 2 Arora A.K. Nord J. Olofinlade O. et al. Esophageal actinomycosis: a case report and review of the literature. Dysphagia. 2003; 18: 27-31 Crossref PubMed Scopus (20) Google Scholar We present a case of symptomatic Actinomyces infection within a radiation-induced esophageal stricture.

Esophageal Actinomycosis in a Fifty-Three-Year-Old Man with HIV: Case Report and Review of the Literature

Patients with advanced HIV infection commonly present with esophageal symptomatology most frequently due to Candida, cytomegalovirus, or herpes simplex virus. We present a case of a 53-year-old man with AIDS and prior esophageal candidiasis and oral aphthous ulcerations, who developed actinomycosis of the esophagus. This article aims to review clinical characteristics of this and seven previously reported cases occurring in HIV-infected patients. Esophageal actinomycosis is frequently preceded by other esophageal disease that likely results in breach of the mucosal barrier, allowing establishment of the infection. Health care providers should be aware of this rare entity, particularly in those with recurring symptoms, so that a timely diagnosis can be made.

Esophageal Actinomycosis: A Case Report and Review of Radiographic Findings

Esophageal Actinomycosis is a rare disease with only two previous reports in the Radiology literature. We present a 27 year-old African American male with a past medical history of a renal transplant for renal disease secondary to lupus who presented with odynophagia. The computed tomography and barium swallow findings are presented as well as a differential diagnosis of infectious esophageal diseases.

Case Report: Esophageal Actinomycosis in a Patient with Acquired Immune Deficiency Syndrome (AIDS)

Case Report: Esophageal Actinomycosis in a Patient with Acquired Immune Deficiency Syndrome (AIDS)

Esophageal actinomycosis

Esophageal actinomycosis is uncommon and has been reported in immunocompetent and immunocompromised patients. A 41-y-old man with a history of heavy alcohol use presented with progressively worsening odynophagia and dysphagia over a 2-wk period. Upper gastrointestinal endoscopy and esophageal biopsy revealed ulceration with Actinomyces and candidal infection. After therapy with intravenous penicillin G followed by oral amoxicillin that led to clinical improvement, repeat upper gastrointestinal endoscopy revealed healing of esophageal ulceration and no evidence of Actinomyces. From this case and a review of the literature regarding clinical symptoms, diagnosis, and treatment, it is clear that esophageal actinomycosis is a cause of odynophagia and dysphagia. Upper gastrointestinal endoscopy and pathologic examination should be carefully evaluated in patients who present with odynophagia and dysphagia.