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Case Reports: Rare disease
Extensive actinomycosis with intracranial and mediastinal involvement: a therapeutic challenge
  1. Farzana Ansari1,
  2. Anil Budania2,
  3. Meenakshi Rao3,3 and
  4. Taruna Yadav4
  1. 1Pacific Medical College & Hospital, Udaipur, Rajasthan, India
  2. 2Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  3. 3Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  4. 4Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  1. Correspondence to Dr Anil Budania; anilbuddy25{at}gmail.com

Abstract

Central nervous system (CNS) involvement by actinomycosis is rare, seen in 2%–3% cases. It mostly spreads to CNS by haematogenous route from a distant primary site such as oral cavity, lung, abdomen or pelvis. Direct CNS extension can also occur. It mostly presents as brain abscess, meningoencephalitis, actinomycetoma, subdural empyema and epidural abscess. We report one case of extensive actinomycosis having intra and extraparenchymal CNS, spinal canal, retropharyngeal and mediastinal involvement. Due to such widespread extension and involvement of vital areas, complete surgical debulking was not possible. In addition to therapeutic resistance to conventional antibiotics, repetitive negative cultures posed significant difficulty in the case management.

  • Dermatology
  • Infection (neurology)
  • Neuroimaging
  • Pathology

https://doi.org/10.1136/bcr-2021-247694

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    Footnotes

    • Contributors FA: diagnosis, management and care of patient; concept and design; planning, literature search; manuscript preparation, editing, review and final drafting. AB: diagnosis, management and care of patient; concept and design; planning, literature search; manuscript preparation, editing, review and final drafting. TY: diagnosis; concept and design; planning, literature search; manuscript preparation, editing, review and final drafting. MR: diagnosis; concept and design; literature search; manuscript editing, review and final drafting.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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