Korean J Gastroenterol.  2013 Feb;61(2):93-96. 10.4166/kjg.2013.61.2.93.

A Case of Esophageal Actinomycosis in a Patient with Normal Immunity

• Kim HS
• Cheon JW
• Kim MS
• Jung CK
• Kim KR
• Choi JW
• Kang DW
• Kim SY

• KMID: 1775773
• DOI: http://doi.org/10.4166/kjg.2013.61.2.93

Abstract

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.

Keyword

Actinomycosis; Esophageal diseases; Immunocompetence

MeSH Terms

Actinomycosis/*diagnosis/drug therapy/immunology
Adult
Amoxicillin/therapeutic use
Anti-Bacterial Agents/therapeutic use
Esophageal Diseases/*diagnosis/drug therapy/immunology
Esophagoscopy
Female
Humans
Immunity
Penicillin G/therapeutic use
Anti-Bacterial Agents
Amoxicillin
Penicillin G

Figure

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  Fig. 1. Endoscopic findings (Initial). A large circumferential ulcer covered with thick exudate was seen at 34 cm to 37 cm from the incisors.

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  Fig. 2. Microscopic findings of endoscopic biopsy specimens (×400). (A) Photomicrograph showed deep purple, fragmentated, sulfur granules within the ulcer debritus with neutrophilic exudate (arrows; H&E). (B) Gram stain showed sulfur granules with gram-positive coccoid form and rare remnants of filaments (Gram stain).

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  Fig. 3. Endoscopic findings (follow-up, 10th days). Decreased depth of ulcer and amount of exudate was noted compared to prior examination, and healing process was noted on the ulcer base.

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  Fig. 4. Endoscopic findings (follow-up, 7th months). The ulcer noted at previous examination was healed into a scar.

Reference

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