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J Thorac Cardiovasc Surg 2004;127:1511-1513
© 2004 The American Association for Thoracic Surgery

Brief communication

Stage III empyema caused by Actinomyces meyeri: A plea for decortication

^a Department ofThoracic and Vascular Surgery University Hospital, Lausanne, Switzerland
^b Department of Pulmonary Medicine, University Hospital, Lausanne, Switzerland

Received for publication October 7, 2003; revisions received November 4, 2003; ^* Address for reprints: Cédric Vallet, Department of Thoracic and Vascular Surgery, University Hospital, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
cvallet@hospvd.ch

The first 20% of the full text of this article appears below.

Dr Vallet

Actinomycosis is a rare infectious disease caused by Actinomyces species, a genus of anaerobic gram-positive bacillus. Actinomyces organisms are saprophytes of the human digestive tract and are very sensitive to penicillin. Thoracic actinomycosis represents 15% to 20% of cases^1-4 with pleural effusion in only 20% of intrathoracic affection.^1,4,5 The usual clinical picture is that of a pleural effusion or pleural empyema together with a parenchymatous infection. We report a case of pleural effusion caused by Actinomyces meyeri without pulmonary involvement that failed to respond to chest tube drainage and antibiotherapy.

Clinical summary

A 64-year-old woman was admitted with a history of fever and a dry cough associated with asthenia, weight loss, and exertional dyspnea. There was no previous medical history except for smoking and alcohol abuse. Laboratory studies showed a hemoglobin value of 9.9 g/100 mL, a hematocrit value of 25%, a leukocyte count of 13,200/mm³, and a sedimentation rate of greater than 120 mm/h. Hemocultures were sterile, and the result of an HIV test was negative. A chest radiograph showed a massive left pleural effusion (Figure 1). Chest tube drainage was performed, and this revealed a purulent effusion. A meyeri was identified after culture of the pleural effusion. Despite treatment with intravenous penicillin (20 Mio IU/d), a loculated pleural effusion developed. Chest computed tomography (CT) demonstrated thickening and enhancement of the parietal pleura and confirmed loculation of pleural effusion and left lower lobe atelectasis (Figure 2). Bronchial carcinoma . . . [Full Text of this Article]