Extensive actinomycosis with intracranial and mediastinal involvement: a therapeutic challenge. Issue 8 (18th August 2022)

• Record Type: Journal Article
• Authors: Ansari, Farzana; Budania, Anil; Rao, Meenakshi; Yadav, Taruna
• Is Part Of: BMJ case reports. Volume 15:Issue 8(2022)
• Publication Date: 2022-08-18
• Subjects: Dermatology -- Infection (neurology) -- Neuroimaging -- Pathology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-247694
• Languages: English
• ISSNs: 1757-790X

Abstract

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.