Thoracic Actinomycosis With Infiltration of the Spine: An Oncological Pitfall.

Thoracic actinomycosis with involvement of the vertebral column and chest wall is rare in children and may resemble malignant tumors. A 12-year-old girl was admitted to our clinic having B-symptoms, cachexia, and painful scoliosis (Karnofsky index 20%). Imaging showed a large thoracic left-sided paravertebral tumor with infiltration of the vertebrae, destruction of the chest wall and multiple intrapulmonary nodules. Initially, Ewing sarcoma was suspected and chemotherapy started without previous biopsies. Definite diagnosis of actinomycosis was established later upon histopathologic examination and successfully treated by ß-lactam antibiotics. Collectively, this case illustrates that actinomycosis can be an oncological pitfall and possible differential diagnosis.

Isolation of Trueperella pyogenes in a case of thoracic and abdominal abscess in a galago (Otolemur garnettii).

BACKGROUND: An adult male galago (Otolemur garnettii) presented for fight wounds following pairing for breeding. Treatment was symptomatic with recovery. Following resolution, the animal re-presented and died, despite additional treatment. METHODS: Necropsy, histopathology, bacterial cultures, and 16S RNA sequencing. RESULTS: A large intrathoracic/intra-abdominal abscess due to Trueperella pyogenes was found at necropsy. CONCLUSIONS: T. pyogenes should be considered in abscesses/wounds of galagos.

A thoracic mass infiltrating the chest wall.

A case of thoracic mass infiltrating the chest wall mimicking a pulmonary invasive neoplasm is reported. Differential diagnosis and characteristic radiological and histological imaging had a decisive role in the case management. Actinomycosis is caused by a gram-positive, filamentous, microaerophilic bacteria. About 15% of the infections caused by Actinomyces involve the thorax. If not promptly diagnosed and treated thoracic actinomycosis may determine contiguous and systemic involvement. Actinomycosis is an anaerobic-to-microaerophilic bacteria and direct identification and isolation are difficult to obtain. In depth discussion diagnostic and therapeutic features are described in this report.

Primary sternal tuberculosis mimicking anterior chest wall tumor: case report.

A case of a sternal mass mimicking a chest wall tumor and finally diagnosed as primary sternal tuberculosis is presented. Fine needle biopsy was inconclusive and surgery included excision and drainage of a large abscess in the soft tissues around the involved bone. Pathology revealed multiple granulomatous and necrotic lesions consistent with tuberculous osteomyelitis. On a 4-drug antituberculous regimen the patient is an excellent condition 6 months later.

Unmasking catamenial hemoptysis in the era of CFTR modulator therapy.

BACKGROUND: Thoracic endometriosis syndrome (TES) is a rare condition that occurs in women when endometriosis implants into the thoracic cavity. Catamenial hemoptysis, the occurrence of hemoptysis with menstruation, is a recognized clinical manifestation of TES commonly treated with hormonal therapy. CASE SUMMARY: We present the first documented case describing the recrudescence of catamenial hemoptysis in the setting of Lumacaftor/Ivacaftor administration in a 25-year-old woman with cystic fibrosis (CF). DISCUSSION: We review the literature on TES, pharmacologic management, and reported cystic fibrosis transmembrane conductance regulator (CFTR) modulator drug interactions. We propose that our patient's recrudescence of catamenial hemoptysis was secondary to a drug-drug interaction between Lumacaftor/Ivacaftor and oral contraceptive therapy. CONCLUSION: Our case suggests that women with CF who have catamenial hemoptysis and a genetic mutation approved for Tezacaftor/Ivacaftor or Elexacaftor/Tezacaftor/Ivacaftor can be managed effectively with either CFTR modulator and hormonal contraceptive therapy.

[Three patients with thoracic actinomycosis]. / Drie patiënten met thoracale actinomycose.

Thoracic actinomycosis was diagnosed in 3 patients. A 39-year-old man with no relevant medical history was admitted with syncope and hemiparesis. Radiological examination of the thorax and cerebrum revealed abnormalities. The second patient was a 50-year-old man with pneumonia that had not responded to multiple courses of different antibiotics. The third patient was a 42-year-old man admitted for evaluation and treatment of hepatopulmonary abnormalities. Actinomyces was cultured from purulent material obtained under anaerobic conditions as far as possible from the first 2 patients; the third patient was diagnosed by histopathological examination. All 3 patients recovered completely after long-term antibiotic therapy. Actinomycosis remains a diagnostic challenge due to the inherent difficulties in culturing anaerobic bacteria. In addition, false-positive results are possible because Actinomyces is present in the oropharynx, digestive tract and female genital tract under normal conditions.

Chest wall abscess: an unusual presentation of Hodgkin's lymphoma.

A chest wall abscess is a very rare presentation of extranodal Hodgkin's lymphoma (HL); only one case has been reported to date. Here, we describe a case of a 38-yr-old man with HL whose initial presentation was a chest wall abscess. The diagnosis of HL was suggested by cytological examination of the purulent discharge and was confirmed subsequently by excisional biopsy of cervical lymph node.

Extrapulmonary thoracic disease caused by Blastomyces dermatitidis.

A case of blastomycosis is reported involving the mediastinum and compromising the plexus brachialis. The pathology, pathophysiology, and treatment of this patient and of a previously reported patient are discussed and compared with the characteristics of extrapulmonary thoracic disease caused by histoplasmosis. Because of the favorable response of these patients to prolonged antifungal therapy, blastomycosis should be considered in the differential diagnosis of invasive extrapulmonary thoracic disease.

Comparison of ceftriaxone with cefotaxime in serious chest infections.

Ceftriaxone is a new, third-generation cephalosporin that, because of its long half-life, offers potential advantages of cost and convenience over similar agents such as cefotaxime. We compared the two drugs in a prospective, randomized study of the treatment of chest infections in seriously ill patients. Fifty-one patients (90 percent of whom were mechanically ventilated) received either ceftriaxone, 2g IV once daily, or cefotaxime, 2 g IV thrice daily, for five days. The two groups of patients appeared demographically comparable. Ceftriaxone in a single daily dose of 2 g once daily may not be satisfactory for the treatment of serious chest infections.

Disseminated Actinomycosis.

A patient with multiple subcutaneous abscesses was found to have disseminated actinomycosis. No predisposing cause was identified. No defects in immunity were found. His disease responded promptly to penicillin therapy.

Thoracic complications of amebic abscess of the liver: report of 501 cases.

During an 18-year period, 501 cases of thoracic complications of amebic abscess of the liver were studied; 175 had inflammatory reactions of thoracic structures (165 with pleural effusions and pneumonitis, ten with pericarditis) and 326 ruptured through the diaphragm (175 into the airways, 106 into the pleural cavity, 5 into the pericardium, 39 into the airways and pleura, and 1 into the pleura and pericardium). The thoracic complication was preceded by a picture suggesting an acute inflammatory process or a chronic wasting disease. Depending on type, the complication itself was signaled by increase or change in character of right upper abdominal or lower thoracic pain, dyspnea, or overt respiratory insufficiency, hemoptysis, and expectoration of necrotic material, sepsis, tamponade, and shock. Chest roentgenograms showed small to massive pleural effusions, basal pneumonitis, and cardiomegaly; serology, liver scans, and induced pneumoperitoneum were diagnostic. Treatment included metronidazole and emetine, drainage of pleural or pericardial contents or promotion of bronchial drainage, and meticulous care of associated respiratory, circulatory, and systemic derangements. Mortality for cases with rupture was 11.4 percent, due mainly to sepsis, shock, respiratory insufficiency, and tamponade. The rest of the patients were discharged in cured or improved condition.

The role of surgery in primary osteomyelitis of the chest wall.

Seven patients with primary osteomyelitis of the chest wall are described. All patients presented with pain at the site of infection, and four patients had a tumor-like mass that could easily be confused with a neoplastic process. All were heroin addicted and pseudomonas was the most common organism cultured. Conservative management with antibiotics for a minimum of 4 weeks is recommended with operation assuming a secondary role, namely, to assist in the initial diagnosis or in the form of limited resection of residual sinuses. Primary wide resection is discouraged.

Surgical treatment of primary sternal osteomyelitis.

Four patients with primary sternal osteomyelitis are described. Pseudomonas aeruginosa was the infective organism. Three of the 4 were heroin addicts. Limited surgical resection with preservation of the posterior periodteum is recommended for an infected sternum. Postoperative antibiotic therapy for a period of six weeks is also recommended. Preservation of the posterior sternal periosteum rather than conventional radical excision is important for maintaining physical stability and avoiding chest wall deformity in the group of patients.

Broncholithiasis and thoracoabdominal actinomycosis from dropped gallstones.

We report a case of successfully managed invasive, thoracoabdominal actinomycosis caused by the intraperitoneal spillage of gallstones during laparoscopic cholecystectomy. The infected gallstones traversed the diaphragm, migrated into the lung parenchyma, and obstructed a segmental bronchus, causing pneumonia. Treatment involved retrieval of the obstructing stone, debridement and drainage of the pleuroperitoneal phlegmon/abscess, and intravenous antibiotics. The case illustrates the need to remove gallstones at the time of cholecystectomy.

Surgical treatment of tuberculous cold abscess of the chest wall.

The incidence of tuberculosis (Tbc) infection is high in some parts of the world and tuberculous cold abscess of the chest wall (CACW) often fails to respond to medical treatment. Medical records of 178 patients who underwent surgical treatment of chest wall abscesses from July 1970 to Sept. 2000 were reviewed and 89 patients who were pathologically confirmed as Tbc cold abscess cases were included in this study. Their ages ranged from 9 to 71 years (mean 33.3 years) and the male to female ratio was 1.2:1 (49 male, 40 female). The symptoms were palpable chest wall mass, pain and pus discharge, and three patients had multiple lesions. Twenty-five patients (28%) underwent excision of chest wall abscesses and 64 patients (72%) underwent chest wall and rib resection. Tbc medication was given preoperatively in 39 patients for an average of 6.3 months and all patients were given Tbc medication postoperatively for an average of 12 months. Postoperative complications were bleeding, pus discharge, empyema, pleural effusion, wound dehiscence, subcutaneous emphysema and activation of pulmonary Tbc. The disease recurred in 7 patients (7.8%) and these 7 patients all underwent a second operation. We recommend preoperative Tbc medication and complete resection of chest wall abscesses including any suspicious ribs. Postoperative Tbc medication for a minimum of 12 months is essential to decrease the risk of a relapse.

Empyema necessitatis: review of the manifestations of thoracic actinomycosis.

Actinomycosis is a relatively uncommon infectious process involving the chest. A case of thoracic actinomycosis mimicking an inflammatory breast carcinoma in an elderly woman is presented with a review of the literature. The authors suggest that considering this disease in the differential diagnosis of indolent pulmonary parenchymal and pleural lesions is essential if appropriate diagnostic tests are to be obtained and proper therapy initiated, thus avoiding unnecessary invasive procedures.

A clinical evaluation of Suprapen (amoxicillin plus flucloxacillin) in the management of childhood thoracic empyema.

Twenty-one children, all suffering from thoracic empyema, were treated with a combination of antibiotic therapy (Suprapen) and tube thoracostomy. A satisfactory clinical response with radiological and laboratory confirmation was seen in all but one patient, thus obviating the need for major surgery. Suprapen may be considered as a first line antibiotic in such cases of pleural sepsis in the absence of bacteriological confirmation of infection.

Primary sternal osteomyelitis.

Primary sternal osteomyelitis is a rare condition. Most of the recent cases have been reported in intravenous drug abusers. A case of primary sternal osteomyelitis with no apparent risk factors is reported. Diagnosing sternal osteomyelitis can be difficult, but failure to clinically recognize this type of infection in its early stages can lead to serious sequelae. The diagnosis should be suspected in a young patient presenting with acute inflammatory swelling over the sternum. It is further supported by leukocytosis, elevated sedimentation rate, lateral radiograph of the sternum, and positive Gram's stain. While bacteriological culture results are pending, antibiotic therapy with Staphylococcus aureus coverage should be initiated empirically. Diagnostic evaluation and management of the patients with this entity are briefly discussed.