Human Actinomycosis: Report of a Rare Case of Disseminated Actinomycosis Presenting as Varicosities and Deep Vein Thrombosis

摘要

Introduction: Human actinomycosis is characterized by the development of chronic granulomatous lesions of the skin and subcutaneous connective tissues. The condition is also called as mycetoma, and typically presents as granulomatous skin with multiple draining sinuses usually affecting the lower limbs. The pus draining from these lesions show characteristic granules, and the laboratory diagnosis greatly depends on the identification of the causative microorganism from the crushed granules. Actinomycosis is a chronic infection and may cause severe complications when the treatment is not initiated at an appropriate time. In this case report we present a rare instance of disseminated actinomycosis in a patient who presented with varicosities and deep vein thrombosis. Case presentation: A-54-year-old male presented with complaints of swelling in the right lower limb, multiple inflammatory swelling like lesions on the thoracic region and chronic lower back pain. The patient started to notice dilated veins on the abdominal wall and around the umbilicus for one month. He was a known case of actinomycosis, who suffered from the complications of mycetoma and had the left leg amputated below the knee. Considering the previous history of the patient, a provisional diagnosis of disseminated actinomycosis was made. Due to the presence of dilated tortuous veins, and the edema varicosities and possible deep vein thrombosis was suspected. Pus was drained from the swelling like lesions, which on microscopy revealed gram-positive filamentous branching bacilli. Culture on Lowenstein-Jensen’s (LJ) medium revealed the growth of red colored non-acid-fast gram-positive filamentous branching bacilli which was identified as Actinomyces species. Conclusion: Human actinomycosis is an underdiagnosed microbial infection. Inadequate treatment could cause disseminated actinomycosis and severe complications as observed in the present case. Bacterial isolation can be hindered by prior antibiotic use and culture on LJ medium may improve the chances of isolation of Actinomyces.