DERMATOPATHOLOGY CASES: Self-Assessment Cases: Editor - Dr Sampurna Roy MD

Digital Images of interesting cases that will include the full spectrum of Dermatopathology, presented in the form of quiz.

The answer of the cases include related links and recent abstracts of articles.

Thursday, December 10, 2009

Answer of Dermatopathology Case 10

Primary Cutaneous Actinomycosis

Visit: Pathology of Actinomycosis
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Cutaneous actinomycosis presenting as chronic mastitis. Clin Exp Dermatol. 2009 Apr 27.
Summary Actinomycosis is a chronic granulomatous suppurative infection caused by anaerobic actinomyces. Primary cutaneous involvement is uncommon because of the exclusively endogenous habitat of the organism. We describe a very unusual presentation mimicking chronic mastitis. A 35-year-old woman presented 7 months post-partum with tenderness and induration in the right breast. She was pyrexial and felt systemically unwell. An initial diagnosis of mastitis was made.Treatment with penicillin, imipenem, co-amoxiclav and metronidazole had no effect. Skin biopsy revealed the characteristic 'sulphur granules' ofactinomycoses in the deep dermis. Long term oral clindamycin (> 12 months) has produced a very good response clinically, with a concomitant decrease ininflammatory markers. Cutaneous actinomycosis has been described by haematogenous spread from visceral organs or after trauma. The organism is difficult to culture and is often diagnosed histologically by the presence of 'sulphur granules'. It is very sensitive to penicillin but prolonged treatment is needed.

Actinomyces meyeri cutaneous actinomycosis.Int J Dermatol. 2009 Feb;48(2):154-6.
Actinomyces meyeri cutaneous actinomycosis is a very rare disease. It often results from contiguous dissemination of an underlying focus. We report a case of pulmonary actinomicosis with secondary cutaneous involvement which led to the diagnosis. A 51-year-old man presented with an indurated, erythematous plaque on his right chest wall. He had been diagnosed with pneumoniae one month prior ago and received antibiotic treatment but symptoms persisted. Fibrobroncoscopy was normal and bronchoalveolar lavage samples were negative. The cutaneous plaque evolved with fistulization and drainage of serohematic material with whitegrains. Actinomyces meyeri was cultured from bacteriologic samples. Ceftriaxone and doxiciclin were administered for a total of 12 months with complete resolution of the clinical condition.

Primary cutaneous actinomycosis.Int J Dermatol. 2008 Dec;47(12):1271-3.
Actinomycosis is a chronic, progressive, suppurative infection, prevalent over the neck, thorax or abdomen. As it rarely occurs with few clinical symptoms, its diagnosis requires a high index of clinical suspicion. We report a case of primary cutaneous actinomycosis affecting the back. The patient was treated with benzyl penicillin and sulfonamides and showed no recurrence at 1 year follow-up.