McLaren Macomb Medical Center Mount Clemens, MI, United States
Alexandra Davies, DO1, Nicholas Daane, DO2, Albert Ross, MD2 1McLaren Macomb Medical Center, Mount Clemens, MI; 2McLaren Greater Lansing, Lansing, MI
Introduction: Actinomyces is a gram-positive, facultatively anaerobic genus of the Actinobacteria class of bacteria. Actinobacteria are residential microbial flora of the oropharynx, gastrointestinal tract, and genitourinary tract. Actinomycetes esophagitis is a rare infectious process reported mostly in immunocompromised patients; literature sources reveal approximately 24 cases reported to date in 2015. We discuss a 92-year-old female in the hopes of providing more information regarding this infectious process.
Case Description/Methods: A 92-year-old female with a history of gastroesophageal reflux disease presented to the emergency department with three weeks of progressive dysphagia. The patient stated initial dysphagia was to solids, and subsequently progressed to difficulty in swallowing liquids and pills. CT of neck and soft tissues was performed that noted transfacial mass involving the left thyroid gland and esophagus, estimated to measure 6 x 4 x 4.8 cm. The mass involved the posterior tracheal wall with mild extension into the lumen and was noted to arise from or invade the cervical esophagus with occlusion or near occlusion. Due to worsening of her symptoms, dehydration, and weight loss, the patient was admitted and the gastroenterology team was consulted for evaluation. The patient underwent esophagogastroduodenoscopy (EGD) which revealed no true esophageal mass, but rather abnormal tissue at the site of stricture which was noted to be invasion by tumor or irritation due to compression; the esophagus appeared normal after the area of stricture, and biopsies were taken of the site. Pathology results noted ulcerative esophagitis and bacterial organism clusters with Actinomyces. Infectious disease was consulted and the patient was initiated on 3 million units q4hr IV penicillin G, with plan of repeat EGD in the outpatient setting.
Discussion: There have been multiple different causes of infectious esophagitis recorded, with actinomyces being one of the rarest. Presenting symptoms are usually nonspecific and entail odynophagia and dysphagia, with imaging and EGD often mimicking malignancy. The findings on imaging studies are consistent with the predisposition of actinomycosis to spread through tissue planes. Overall, our case highlights the importance of carefully evaluating endoscopy and pathologic examination in patients who present with odynophagia and dysphagia.
Figure: Figure 1: Abnormal tissue at site of stricture
Disclosures: Alexandra Davies indicated no relevant financial relationships. Nicholas Daane indicated no relevant financial relationships. Albert Ross indicated no relevant financial relationships.
Alexandra Davies, DO1, Nicholas Daane, DO2, Albert Ross, MD2. P0369 - Actinomyces Esophagitis Presenting as Esophageal Mass, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.