Actinomycose pulmonaire disséminée avec atteinte hépatique : une forme trompeuse mimant un tableau polymétastatique
L’actinomycose thoracique, due à une bactérie du genre Actinomyces, est une pathologie infectieuse rare, de mauvais pronostic en l’absence de traitement, dont le tableau clinicoradiologique est trompeur, pouvant simuler une pathologie tumorale ou tuberculeuse. C’est un cas d’actinomycose pulmonaire...
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| Vydané v: | Revue de pneumologie clinique Ročník 68; číslo 1; s. 40 - 44 |
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| Jazyk: | French |
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Elsevier Masson SAS
01.02.2012
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| ISSN: | 0761-8417 |
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| Abstract | L’actinomycose thoracique, due à une bactérie du genre Actinomyces, est une pathologie infectieuse rare, de mauvais pronostic en l’absence de traitement, dont le tableau clinicoradiologique est trompeur, pouvant simuler une pathologie tumorale ou tuberculeuse.
C’est un cas d’actinomycose pulmonaire pseudotumorale généralisée chez un homme de 48ans, non alcoolotabagique, présentant depuis un mois une toux avec crachats hémoptoïques, une dyspnée associée à une fièvre et une altération de l’état général. L’examen clinique retrouvait un amaigrissement, des râles crépitants diffus et des caries dentaires multiples. Il présentait biologiquement un syndrome inflammatoire. Les imageries radiologiques et scannographiques pulmonaires et hépatiques retrouvaient une masse périphérique pulmonaire droite associée à des opacités nodulaires multiples en lâcher de ballon, des lésions hépatiques multiples d’allure métastatique. L’examen bactériologique du liquide de lavage broncho-alvéolaire (examen direct et culture) et la biopsie transpariétale de la masse pulmonaire confirmaient la présence d’Actinomyces. L’évolution sous pénicilline G 10 millions d’unité internationale par jour par voie parentérale pendant six semaines relayée par Amoxicilline-acide clavulanique trois grammes par jour pendant 12 mois et après une mise en état bucco dentaire était favorable. Le scanner thoraco-abdominal réalisé trois mois après le traitement montrait une disparition complète des lésions.
Notre cas illustre la difficulté diagnostique de l’actinomycose surtout devant un tableau de métastase multiple pulmonaire et hépatique. D’où l’importance d’un examen histologique et bactériologique des prélèvements. Le pronostic de cette affection est généralement bon après un traitement bien conduit et prolongé ; et le pronostic propre aux formes disséminées est moins bien connu.
Thoracic actinomycosis, caused by bacteria of the Actinomyces genus, is a rare infection, with poor prognosis if untreated, whose clinical and radiological picture is misleading, which can simulate a tumoral or tuberculous disease.
This is a case of generalised pseudotumoral pulmonary actinomycosis in a non-smoking, non-drinking 48-year-old man, who for one month has been presenting a cough with haemoptoic sputum, dyspnoea associated with fever and a deterioration in general condition. The clinical examination discovered weight loss, diffuse crackling rales and multiple dental caries. Biologically, he presented an inflammatory syndrome. The radiological imaging and lung and liver CT-scans discovered a peripheral lung mass right side associated with multiple nodular cannon-ball opacities, multiple liver lesions of metastatic appearance. The bacteriological examination of the bronchoalveolar lavage fluid (Gram stain and culture) and the transparietal biopsy of the lung mass confirmed the presence of Actinomyces. Progress under treatment with 10 million international units of parenteral penicillin G daily over a period of six weeks substituted by three grams of amoxicillin/clavulanic acid daily over a period of 12 months and following an oral preparatory procedure was favourable. The thoraco-abdominal scan carried out three months after the treatment showed that the lesions had completely disappeared.
Our case illustrates the diagnostic difficulty of actinomycosis particularly faced with a picture of multiple lung and liver metastasis. Hence, the importance of a histological and bacteriological examination of samples. The prognosis of this complaint is generally good following well-managed, prolonged treatment; and the prognosis peculiar to disseminated forms is less certain. |
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| AbstractList | L’actinomycose thoracique, due à une bactérie du genre Actinomyces, est une pathologie infectieuse rare, de mauvais pronostic en l’absence de traitement, dont le tableau clinicoradiologique est trompeur, pouvant simuler une pathologie tumorale ou tuberculeuse.
C’est un cas d’actinomycose pulmonaire pseudotumorale généralisée chez un homme de 48ans, non alcoolotabagique, présentant depuis un mois une toux avec crachats hémoptoïques, une dyspnée associée à une fièvre et une altération de l’état général. L’examen clinique retrouvait un amaigrissement, des râles crépitants diffus et des caries dentaires multiples. Il présentait biologiquement un syndrome inflammatoire. Les imageries radiologiques et scannographiques pulmonaires et hépatiques retrouvaient une masse périphérique pulmonaire droite associée à des opacités nodulaires multiples en lâcher de ballon, des lésions hépatiques multiples d’allure métastatique. L’examen bactériologique du liquide de lavage broncho-alvéolaire (examen direct et culture) et la biopsie transpariétale de la masse pulmonaire confirmaient la présence d’Actinomyces. L’évolution sous pénicilline G 10 millions d’unité internationale par jour par voie parentérale pendant six semaines relayée par Amoxicilline-acide clavulanique trois grammes par jour pendant 12 mois et après une mise en état bucco dentaire était favorable. Le scanner thoraco-abdominal réalisé trois mois après le traitement montrait une disparition complète des lésions.
Notre cas illustre la difficulté diagnostique de l’actinomycose surtout devant un tableau de métastase multiple pulmonaire et hépatique. D’où l’importance d’un examen histologique et bactériologique des prélèvements. Le pronostic de cette affection est généralement bon après un traitement bien conduit et prolongé ; et le pronostic propre aux formes disséminées est moins bien connu.
Thoracic actinomycosis, caused by bacteria of the Actinomyces genus, is a rare infection, with poor prognosis if untreated, whose clinical and radiological picture is misleading, which can simulate a tumoral or tuberculous disease.
This is a case of generalised pseudotumoral pulmonary actinomycosis in a non-smoking, non-drinking 48-year-old man, who for one month has been presenting a cough with haemoptoic sputum, dyspnoea associated with fever and a deterioration in general condition. The clinical examination discovered weight loss, diffuse crackling rales and multiple dental caries. Biologically, he presented an inflammatory syndrome. The radiological imaging and lung and liver CT-scans discovered a peripheral lung mass right side associated with multiple nodular cannon-ball opacities, multiple liver lesions of metastatic appearance. The bacteriological examination of the bronchoalveolar lavage fluid (Gram stain and culture) and the transparietal biopsy of the lung mass confirmed the presence of Actinomyces. Progress under treatment with 10 million international units of parenteral penicillin G daily over a period of six weeks substituted by three grams of amoxicillin/clavulanic acid daily over a period of 12 months and following an oral preparatory procedure was favourable. The thoraco-abdominal scan carried out three months after the treatment showed that the lesions had completely disappeared.
Our case illustrates the diagnostic difficulty of actinomycosis particularly faced with a picture of multiple lung and liver metastasis. Hence, the importance of a histological and bacteriological examination of samples. The prognosis of this complaint is generally good following well-managed, prolonged treatment; and the prognosis peculiar to disseminated forms is less certain. |
| Author | Andrianasolo, R. Andrianarisoa, A.C.F. Rakotomizao, J.R. Rakotoson, J.L. Rakotoharivelo, H. |
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| CitedBy_id | crossref_primary_10_1016_j_pneumo_2018_05_001 crossref_primary_10_1016_j_revmed_2020_03_002 crossref_primary_10_3748_wjg_v20_i43_16372 |
| Cites_doi | 10.4065/84.2.123 10.2214/ajr.155.6.2122663 10.1148/radiology.183.1.1549670 10.1097/SMJ.0b013e3181864c1f 10.1183/09031936.03.00089103 10.4065/79.7.895 10.1378/chest.07-2128 10.3904/kjim.2002.17.3.207 10.2214/ajr.110.4.707 10.1378/chest.121.6.2069 10.1378/chest.99.2.493 10.1590/S1806-37132009001100014 |
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| Keywords | Infection Hepatic actinomycosis Actinomyces Pseudotumoral form Actinomycose hépatique Thoracic actinomycosis Forme pseudotumorale Actinomycose thoracique Actinomycose pulmonaire Disséminé Actinomycetaceae Bactériose Foie Pathologie de l'appareil respiratoire Pseudotumeur Forme Actinomycetales Pathologie des poumons Pneumologie Actinomycetes Bactérie Blessure |
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| References_xml | – volume: 79 start-page: 895 year: 2004 end-page: 898 ident: bib0055 article-title: Clinicoradiological features of pulmonary infarctions mimicking lung cancer publication-title: Mayo Clin Proc – volume: 84 start-page: 123 year: 2009 end-page: 128 ident: bib0020 article-title: Bronchopulmonary actinomycosis and hiatal hernia publication-title: Mayo Clin Proc – volume: 110 start-page: 707 year: 1970 end-page: 716 ident: bib0050 article-title: The Roentgen manifestations of thoracic actinomycosis publication-title: AJR – volume: 17 start-page: 207 year: 2002 end-page: 210 ident: bib0085 article-title: Foreign body-induced actinomycosis mimicking bronchogenic carcinoma publication-title: Korean J Intern Med – volume: 99 start-page: 493 year: 1991 end-page: 495 ident: bib0045 article-title: Endobronchial actinomycosis simulating bronchogenic carcinoma: diagnosis by bronchial biopsy publication-title: Chest – volume: 35 start-page: 1152 year: 2009 end-page: 1155 ident: bib0080 article-title: A rare case of co-infection with pulmonary tuberculosis and oronasal actinomycosis publication-title: J Bras Pneumol – volume: 10 start-page: 557 year: 1993 end-page: 559 ident: bib0095 article-title: L’actinomycose thoracique à propos de deux cas publication-title: Rev Mal Respir – volume: 16 start-page: 572 year: 1999 end-page: 574 ident: bib0075 article-title: Opacité pulmonaire inhomogène pseudotumorale publication-title: Rev Mal Respir – volume: 121 start-page: 2069 year: 2002 end-page: 2072 ident: bib0090 article-title: Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature publication-title: Chest – volume: 155 start-page: 1183 year: 1990 end-page: 1184 ident: bib0060 article-title: Misdiagnosis or missed diagnosis? 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| SubjectTerms | Actinomyces Actinomycose hépatique Actinomycose thoracique Bactérioses Bactérioses de l'appareil respiratoire Bactérioses humaines Forme pseudotumorale Hepatic actinomycosis Infection Pathologie infectieuse Pneumologie Pseudotumoral form Sciences biologiques et medicales Sciences medicales Thoracic actinomycosis |
| Title | Actinomycose pulmonaire disséminée avec atteinte hépatique : une forme trompeuse mimant un tableau polymétastatique |
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