Joana Branco1, Guilherme Lourenço1, Oliveira Santos2, João Neves1, Flora Candeias1, Catarina Gouveia1, Maria João Brito1

1Infectious Diseases Unit, 2Pneumology Unit. Head of Department Goncalo Cordeiro Ferreira. Hospital Dona Estefânia. CHLC-EPE Lisbon. PORTUGAL

ACTINOMYCOSIS IN CHILDREN - When common symptoms lead to an uncommon disease

Actinomyces organisms are part of the endogenous oral flora in humans and rarely cause disease in children. Lung involvement is uncommon and may mimic tuberculosis or neoplastic disorders. Pulmonary actinomycosis should be considered in the differential diagnosis of persistent lung infiltration.

Introduction

Discussion

Even in the presence of extensive disease medical treatment with antibiotics can be effective, thus avoiding a highly complex surgery and retaining lung capacity. Hemoptysis is a rare symptom, and digital clubbing has not been described before. As is common in children, no risk factors were identified.

Sulfur granules

ACTINOMYCOSIS

BIBLIOGRAPHY-  Albar Rawia F, Alqurashi Mansour A; “Pediatric Pulmonary Actinomycosis: Case Report and Review of Literature”; Kingdom of Saudi Arabia; Current Pediatric Research, International Journal of Pediatrics - 0971-9032; 2016.-  Florent Valour, Agathe Sénéchal; “Actinomycosis: etiology, clinical features, diagnosis, treatment, and management”; Lyon, France; Infect Drug Resist. 2014; 7: 183–197.-  David W. Kimberlin, MD, FAAP; Michael T. Brady, MD, FAAP; Section 3: Summaries of Infectious Diseases › Actinomycosis; Red Book® 2015 - Committee on Infectious Diseases; American Academy of Pediatrics.

5 years old

PMH: Microcytic anemia, not investigated

X-Ray: Heterogeneous hypotransparency of the RU lobe

Pneumonia ? à Azithromycin 5 days7 MONTHS - COUGH PERSISTED

Dental cavities. No fever

Homogeneous hypo- transparency, RU and M lobes

Consolidation of RU and M lobes with bronchiectasis

Epithelized mass in the RU lobe bronchus

Productive cough + Nonmassive HEMOPTYSIS

HEMOPTYSIS + DIGITAL CLUBBING

X-Ray

Hb 9.8g/dL, VGM 63.9fL, HGM 19.7pgLeuk 11600/uL Sed Rate 54mm/h

CRP 82.5mg/L Negative blood culture

Penicillin + Clindamycin IV - 4 weeks Amoxicillin oral - 8 months

Significant clinical and radiologic improvement

Exclusion of:- Tuberculosis or fungal infection- Immunodeficiency disorder

X-Ray

SURGERY IS UNNECESSARY

Negative cultural examination of BAL

Bronchofibroscopy

joanarsbranco@hotmail.com

Bronchofibroscopy Chest CT