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Case report
Mixed Actinomyces israelii and Aggregatibacter actinomycetemcomitans infection causing empyema necessitatis and multiple skin abscesses in an immunocompetent patient
  1. Takaaki Kobayashi1,
  2. Evgeny Arshava2,
  3. Bradley Ford3 and
  4. Poorani Sekar1
  1. 1 Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  3. 3 Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Takaaki Kobayashi, taka.kobayashi1126{at}


A 45-year-old- man presented with left chest wall pain, swelling and cough. Over a 2-month period he developed abscesses in the right foot, right anterior thigh, left buttock and left chest. Incision and drainage of the soft tissue abscesses and video-assisted thoracoscopic surgery to drain the loculated empyema contiguous with the chest wall abscess were performed as surgical management. Gram stain showed beaded Gram-positive rods and the culture initially grew Aggregatibacter actinomycetemcomitans and Eikenella corrodens. Pathological evaluation of the pleura showed sulfur granules and organisms consistent with Actinomyces spp. on Gomori methenamine silver stain; Actinomyces israelii was recovered in culture with extended incubation. The patient was treated for 3 weeks with ceftriaxone and oral metronidazole, followed by oral amoxicillin. Culture of A. actinomycetemcomitans with other findings consistent with actinomycosis warrants 6–12 months of antibiotic therapy.

  • infectious diseases
  • surgery
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  • Contributors TK wrote the first draft of the manuscript. PS, BF and EA critically reviewed and revised the manuscript. All authors read and approved the final paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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