A Case of Disseminated Infection due to Actinomyces: NEJM
A 58-year-old man presented to the pulmonary clinic with a productive cough and a history of weight loss of 10 kg during the preceding 3 months. He was an active smoker and for the preceding 4 years had worked in a factory processing cotton. The patient was afebrile, and breath sounds were normal on auscultation of the lungs.

CT chest and abdomen revealed multiple pulmonary nodules (Panel A) associated with pericardial effusion, pleural effusions in both lungs, and multiple liver lesions. Biopsy of the lung was performed with the use of video-assisted thoracoscopic surgery.

Multiple lesions containing sulfur granules characteristic of actinomycosis were observed along the bronchial vascular bundle (Panels B and C, with Panel C providing a close-up view of the circled area in Panel B; staining with hematoxylin and eosin). Filamentous bacteria were highlighted on silver staining (Panel D).

The patient received a diagnosis of disseminated actinomycosis, an uncommon, slowly progressive bacterial infection caused by actinomyces species that can be manifested in the formation of multiple abscesses and sulfur granules in infected tissue.

The patient received a 4-week course of high-dose penicillin intravenously, which was followed by an extended course of oral amoxicillin.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1802090
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