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Management Of Thoracic Actinomycosis Via MIT
MOHAMED S. MAHBOOB ALI;
ADVANCED MEDICAL AND DENTAL INSTITUTE(AMDI), GEORGETOWN, Malaysia
BACKGROUND: Two pediatric patients presented with low-grade fever, loss of appetite, weight loss, and chest wall swelling. CT scan of the thorax revealed the presence of multiple lung nodules and chest wall collections with pleural effusion. The diagnosis was made with a lung biopsy. Both patients were started on Penicillin-G. Surgical treatment is considered when medical treatment fails or complications arise. Thoracic Actinomycosis is quite rare in children. Thus, clinicians must have a high index of suspicion of this diagnosis
METHODS: This is a retrospective case-cohort study with similar findings and diagnosis presented to our centre
RESULTS: Case 1
A 5-year-old boy was referred for soft tissue swelling of the chest wall. He presented with a three-month history of loss of weight, appetite, and low-grade fever. He developed a progressive right-sided chest wall swelling. It was tender, and the overlying skin was inflamed. Chest x-ray showed consolidative changes over the right upper and lower lobe. CT thorax revealed a right lateral chest wall lesion with a depth of 1.1 cm associated with infective lung changes and pleural effusion. Right thoracotomy, decortication and drainage were performed Case 2An 8-year-old boy presented with a two-month history of intermittent fever associated with loss of appetite and weight. He then developed a left-sided chest wall swelling tender with erythematous skin changes. Chest x-ray showed consolidative changes in the left hilar region. CT scan of the thorax revealed a left inferior chest wall collection, lung nodules with bilateral pleural effusion and mediastinal mass. Left thoracotomy and chest wall biopsy were performed
CONCLUSIONS: Thoracic Actinomycosis has a poor prognosis compared to other lung diseases. Thoracic Actinomycosis is challenging to diagnose due to the rarity of the disease, especially in children. In addition, the two described cases showed that Actinomycosis could mimic other lung pathologies. In conclusion, thoracic Actinomycosis is a rare disease with a good prognosis if treated early.
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