Brain Actinomycosis: Brain Actinomycosis: Report of one caseReport of one case

Jorge L. Rivera-Rodriguez, MD, Jorge L. Rivera-Rodriguez, MD, Eugenia Zurita,CNS.Eugenia Zurita,CNS.

Hospital General de Acapulco SSAHospital General de Acapulco SSA

MéxicoMéxico

IntroductionIntroduction

Actinomycosis is an infection primarily Actinomycosis is an infection primarily caused by the bacterium caused by the bacterium Actinomyces Actinomyces israelii.israelii.

Actinomycosis located in the central nervous Actinomycosis located in the central nervous system is an extremely uncommon event.system is an extremely uncommon event.

It may affect immunocompetent or It may affect immunocompetent or immunodefficient subjects.immunodefficient subjects.

It is commonly misdiagnosed in routine It is commonly misdiagnosed in routine imaging studiesimaging studies

Medical HistoryMedical History

Female, 32 y.o. Previously healthy. Recent Female, 32 y.o. Previously healthy. Recent onset of right extremities partial motor onset of right extremities partial motor epilepsy.epilepsy.

A Brain scan showed: left parietal 2 cm solid A Brain scan showed: left parietal 2 cm solid mass, IV contrast inhancing, important mass, IV contrast inhancing, important periferic oedema.periferic oedema.

Negative Chest XrayNegative Chest Xray

No neck masses.No neck masses.

Preoperative ScanPreoperative Scan

Differential DiagnosisDifferential Diagnosis

Primary tumor.Primary tumor.

Brain Abscess.Brain Abscess.

Granuloma.Granuloma.

A parietal craniotomy and total resection of A parietal craniotomy and total resection of the lesion was performed.the lesion was performed.

Hystopathological report:Hystopathological report:

Brain ActinomycosisBrain Actinomycosis

Postoperative Brain ScanPostoperative Brain Scan

No additional No additional antimycrobial therapy antimycrobial therapy was given.was given.Total neurological Total neurological recovery.recovery.Clean long term Clean long term scanning.scanning.Seizure free without Seizure free without antiepileptic drugs at antiepileptic drugs at present.present.

ConclusionsConclusions

Brain Actinomycosis is a rare entity and Brain Actinomycosis is a rare entity and should be considered in any brain mass should be considered in any brain mass differential diagnosis.differential diagnosis.

Total surgical removal without long term Total surgical removal without long term antimycrobial therapy seems to be antimycrobial therapy seems to be effective, but more studies should be effective, but more studies should be performed.performed.

BibliographyBibliography

Allen HA, Scatarige JC, Kim MH. Actinomycosis: CT findings in 6 patients. Am J Radiol Allen HA, Scatarige JC, Kim MH. Actinomycosis: CT findings in 6 patients. Am J Radiol 1987;149:1255-1258.1987;149:1255-1258.Bartels LJ, Vrabec DP. Cervicofacial actinomycosis. Arch Otolaringol 1978;104:705-708.Bartels LJ, Vrabec DP. Cervicofacial actinomycosis. Arch Otolaringol 1978;104:705-708.Bennhoff DF. Actinomycosis: diagnostic and therapeutic considerations and a review of 32 Bennhoff DF. Actinomycosis: diagnostic and therapeutic considerations and a review of 32 cases. Laryngoscope 1984;94:1198-1217.cases. Laryngoscope 1984;94:1198-1217.Dos Santos Junio EA, Pitella JE. Actinomycosis ot the brain: case report. Arq Dos Santos Junio EA, Pitella JE. Actinomycosis ot the brain: case report. Arq Neuropsiquiatr.1999;57(3A):689-694.Neuropsiquiatr.1999;57(3A):689-694.Harvey JC, Cantrell JR, Fisher AM. Actinomycosis: its recognition and treatment. Ann Intern Med Harvey JC, Cantrell JR, Fisher AM. Actinomycosis: its recognition and treatment. Ann Intern Med 1957;46:868-885.1957;46:868-885.Lotier J, Venet C, Chambonniere ML. Multiple actinomycosis brain abscesses. Presse Lotier J, Venet C, Chambonniere ML. Multiple actinomycosis brain abscesses. Presse Med.2004;33(5):318-320.Med.2004;33(5):318-320.Macfarlane DJ,Tucker LG, Kemp LJ. Treatment of recalcitrant actinomycosis with cyprofloxacin. J Macfarlane DJ,Tucker LG, Kemp LJ. Treatment of recalcitrant actinomycosis with cyprofloxacin. J Infect 1993;27:177-180.Infect 1993;27:177-180.Norman JE. Cervicofacial actinomycosis. Oral Surg Oral Med Oral Pathol 1970;29:735-744.Norman JE. Cervicofacial actinomycosis. Oral Surg Oral Med Oral Pathol 1970;29:735-744.Rankow RM, Abraham DM. Actinomycosis: masquerader in the head and neck. Ann Otol Rhinol Rankow RM, Abraham DM. Actinomycosis: masquerader in the head and neck. Ann Otol Rhinol Laryngol 1978;87:230-237.Laryngol 1978;87:230-237.Smego RA. Actinomycosis of the central nervous system. Rev Infect Dis 1987;9:855-865Smego RA. Actinomycosis of the central nervous system. Rev Infect Dis 1987;9:855-865Sudkaker, Selvin S, Rose JJ. Short term treatment of Acinomycosis two cases and a review. Clin Sudkaker, Selvin S, Rose JJ. Short term treatment of Acinomycosis two cases and a review. Clin Infect Dis 2004;2:444-448.Infect Dis 2004;2:444-448.