CRA55 MULTIFACETAD PRESENTATIONS OF ACTINOMYCOSIS: A CASE SERIES ANALYSIS

Affida Ahmad1, Wong Yen Shen1, Am Basheri Alias1, Aisya Natasya Musa1
1Universiti Teknologi MARA (UiTM), Puncal Alam Selangor, Malaysia

Introduction:

Actinomycosis, an uncommon infection caused by gram-positive filamentous, branching bacteria from the Actinomycetaceae family, manifests in diverse clinical presentations. This case series presents three distinct cases to underscore the varied clinical phenotypes of actinomycosis. 

Case report:

The first case involves a 39-year-old asymptomatic woman with an incidental chest radiographic finding of a thick wall cavity in the left upper zone. CT Thorax showed left upper lobe bronchiectasis with soft tissue component within the bronchi. A cauliflower-like mass was seen on bronchoscopy in LB2. Histopathological examination revealed characteristic basophilic granular material suggestive of actinomycetes, prompting successful treatment with amoxicillin for one year. In the second case, a 59-year-old woman presented with constitutional symptoms and abdominal pain. Imaging studies revealed a pelvic mass with an old intrauterine device (IUD). There were also multiple lung nodules. A cervical biopsy was done which confirmed to harbour actinomyces species. Removal of the IUD and oral Augmentin for six months led to symptomatic improvement and resolution of radiological abnormalities. The third case involves a 34-year-old man presenting with persistent cough and a lung cavity on imaging, initially managed as a lung abscess. Despite initial improvement with six weeks of antibiotics, subsequent worsening of symptoms and radiological changes prompted surgical intervention, leading to successful resolution post lobectomy. Histopathology of the lung tissue was positive for actinomycetes.

Discussion:

These cases highlight the diverse clinical presentations of actinomycosis, emphasizing the importance of recognizing this rare entity for timely and effective management. Increased awareness among clinicians is crucial to prevent diagnostic delays and ensure favourable patient outcomes.