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• W3206835174 abstract "TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: To our knowledge, this is the first case of severe A. graevenitzii infection in a previously healthy, immunocompetent adolescent. CASE PRESENTATION: A previously healthy 17-year-old white male presented with a 3-week history of cough, fever, chills, night sweats and weight loss. He was brought to the ED with difficulty breathing and abdominal pain. He denied significant medical history/sick contacts. Mother recalled that he had severe allergy to penicillin as a toddler but had tolerated cefdinir in the past. The patient was noted to be febrile to 40°C, with tachypnea, an oxygen saturation of 90% on room air, bilateral crackles and hepatosplenomegaly. Laboratory evaluation showed leukocytosis of 16000 with 77% neutrophils and elevated liver enzymes. He was admitted with a diagnosis of pneumonia and hepatitis and oxygen via high-flow nasal cannula and antibiotics (vancomycin and ceftriaxone) were initiated. Imaging showed evidence of pneumonia, bilateral mediastinal lymphadenopathy with hilar necrosis, bronchial narrowing and hepatosplenomegaly. Differential included malignancy, sarcoidosis or infections like mycobacteria/HIV/fungi. He underwent bronchoscopy and hilar lymph node biopsy. Histopathological examination showed inflammation (Figure 1) and biopsy tissue cultures grew Actinomyces graevenitzii. Testing for HIV and other etiologies was negative. Antibiotics were changed to doxycycline, given the history of allergy to penicillin, however, testing ruled out penicillin allergy. The antibiotics were switched after 1 week to oral amoxicillin. The patient completed 12-months of therapy with complete clinical resolution of symptoms, radiologic resolution of lymphadenopathy and hepatosplenomegaly. No symptom recurrences were noted at 3 and 6 month follow-up. DISCUSSION: Actinomyces graevenitzii has been rarely reported in adults, but not in pediatrics. To our knowledge, this is the first case of an adolescent presenting with pulmonary actinomycosis with dissemination due to infection with A. graevenitzii species, successfully treated with 12-months of antibiotics with complete clinical and radiologic resolution. A. graevenitzii was first isolated in 1997 by Ramos et al via 16S ribosomal RNA sequencing. In our patient, we isolated A. graevenitzii from mediastinal lymph node biopsies. A. graevenitzii tends to grow faster (48h-96h) and can be cultured anaerobically for up to 3 weeks, resulting in more aggressive and faster disease courses compared to those typically seen in actinomycosis. Actinomycosis requires prolonged treatment with penicillin class of drugs/doxycycline if penicillin allergic. Many reported cases in adults have needed surgical resection. Our patient was successfully treated with antibiotics alone. CONCLUSIONS: Although rare, this aggressive Actinomyces species can cause severe pulmonary disease in healthy hosts, and resolution after long-term antibiotic courses is achievable. REFERENCE #1: Gliga S, Devaux M, Gosset Woimant M, Mompoint D, Perronne C, Davido B. Actinomyces graevenitzii pulmonary abscess mimicking tuberculosis in a healthy young man. Can Respir J. 2014 November/December;21(6):e75-e77. doi: 10.1155/2014/841480. PMID: 25493591; PMCID: PMC4266159 REFERENCE #2: Fujita Y, Iikura M, Horio Y, Ohkusu K, Kobayashi N. Pulmonary Actinomyces graevenitzii infection presenting as organizing pneumonia diagnosed by PCR analysis. J Med Microbiol. 2012 Aug;61(Pt 8):1156-1158. doi: 10.1099/jmm.0.040394-0. Epub 2012 Apr 19. PMID: 22516132. DISCLOSURES: no disclosure on file for Jeremy Berg; No relevant relationships by Sandeep Gupta, source=Web Response No relevant relationships by Ashlesha Kaushik, source=Web Response No relevant relationships by Lauren Norman, source=Web Response" @default.
• W3206835174 created "2021-10-25" @default.
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• W3206835174 date "2021-10-01" @default.
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• W3206835174 title "A RARE REPORT OF SEVERE PULMONARY INFECTION WITH ACTINOMYCES GRAEVENITZII IN AN IMMUNOCOMPETENT ADOLESCENT PATIENT" @default.
• W3206835174 doi "https://doi.org/10.1016/j.chest.2021.07.396" @default.
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