Keywords
Actinomyces spp.
generalized lymphadenopathy
differential diagnosis
histopathology
lymphoma
How to Cite
Abstract
Cervicofacial actinomycosis is the most common and classic form of a rare disease caused by bacteria belonging to the Actinomyces genus, but it sporadically causes generalized lymphadenopathy. The slow growth of the microorganism on in vitro media and the specific requirements of microbiological culture often make its isolation from biological material collected from swabs and tissue biopsies difficult. Clinical manifestations of actinomycosis may mimic malignancies of the head or neck, in which a delay in establishing a final clinical diagnosis is particularly unfavorable, such as Hodgkin’s or nonHodgkin’s lymphomas, cancer of the thyroid, oral cavity, pharynx and larynx, lung cancer or metastases from other internal organs. In the study, we present the case of a 43year old patient who was admitted to the university department for a differential diagnosis of cervical and axillary lymphadenopathy with suspected parasitic infection. Previously performed pathomorphological examinations of the material obtained from numerous lymph node biopsies did not confirm any neoplastic disease, and the image of the pathological changes observed in the computed tomography scan indicated a reactive inflammatory process. The enhanced multidirectional diagnostics was performed for infectious and connective tissue diseases, which failed to identify the cause of chronic lymphadenopathy. Retrospective microbiological revision of histopathological samples from enlarged lymph nodes allowed for the unexpected confirmation of actinomycosis. The patient received combined, targeted systemic antibiotic therapy, which resulted in regression of inflammatory changes in the lymph nodes. The presented case demonstrates the need to consider rare infectious diseases in the differential diagnosis of lymphadenopathy in everyday medical practice and draws attention to the possibility of revision of the diagnosis using preserved pathomorphological preparations.
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