Remedy Publications LLC. Clinics in Respiratory Medicine 2018 | Volume 1 | Issue 2 | Article 1006 1 Thoracic Actinomycosis with Empyema Necessitans: Successful Enteral Antimicrobial Therapy after Pathologic Diagnosis from Superfcial Chest Wall Biopsy OPEN ACCESS *Correspondence: Aubrey Armento, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045 Colorado, E-mail: Aubrey.Armento@ childrenscolorado.org Received Date: 26 Mar 2018 Accepted Date: 16 May 2018 Published Date: 23 May 2018 Citation: Armento A, Bush D, Martiniano S, Jedlicka P, Weinman J, Searns J. Thoracic Actinomycosis with Empyema Necessitans: Successful Enteral Antimicrobial Therapy after Pathologic Diagnosis from Superfcial Chest Wall Biopsy. Clin Respirat Med. 2018; 1(2): 1006. Copyright © 2018 Aubrey Armento. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case Report Published: 23 May, 2018 Abstr act A10-year-old female presented with cough and an anterior chest wall mass and was diagnosed with thoracic actinomycosis and empyema necessitans based on sof tissue biopsy. Oralantimicrobial therapy was used exclusively instead of an initial intravenous course with complete resolution of symptoms and substantial improvement of radiographic fndings. Keywords: Toracic actinomycosis; Empyema necessitans; Enteral antimicrobial therapy Introduction Toracic actinomycosis is a rare, invasive bacterial disease most commonly caused by Actinomycesisraelii, a gram positive flamentous branching bacilli. Pulmonary infection can present with pulmonary abscesses, empyema, or pleurodermal sinus tracts [1]. Patients present with cough, shortness of breath, fever, and occasionally hemoptysis and can have a palpable chest wall mass on physical exam. Development of thoracic actinomycosis infection is commonly attributed to aspiration of oropharyngeal secretions. Actinomycosis is less common in children than adults, but identifed risk factors in children include dental caries, trauma, debilitation, and diabetes mellitus [2-5]. Ofen the diagnosis of thoracic actinomycosis depends upon histopathologic examination of a biopsy sample. Gram positive flamentous branching bacteria at the periphery of a characteristic sulfur granule are suggestive of actinomycosis. Te mainstay of treatment includes prolonged antimicrobial therapy, usually two to six weeks of intravenous penicillin G followed by oral penicillin for 6 to 12 months, though shorter successful courses have been reported [5]. Actinomyces also have in vitro susceptibility to other antibiotics including amoxicillin, doxycycline, and clindamycin, which have been used efectively [4]. Surgical resection may be indicated if the patient has extensive necrosis, sinus tracts, or fstulas [3]. Te eventual need for surgical resection has been reported as high as 50% in thoracic actinomycosis [2]. Case Presentation A 10-year-old female presented to her primary care clinic with a cough and a non-tender lump on her chest wall. Te cough had been ongoing for three weeks and was occasionally productive of scant clear sputum. Early in the course, she had one episode of blood-streaked sputum but denied frank hemoptysis. One week prior to presentation, her mother noted a palpable round lump on the right anterior chest. Tere were no reported fevers, but a three-pound weight loss was noted throughout the month prior to presentation. Her review of systems was otherwise negative. Te patient was born prematurely at 30 weeks gestational age in Mexico. Her medical history was signifcant for mild cerebral palsy, hearing loss, seizure disorder and developmental delay. She emigrated from Mexico to the United States at age 6 years and continued to visit Mexico twice annually since immigrating. During her visits to Mexico, she was routinely exposed to horses, cattle Aubrey Armento 1 *, Douglas Bush 1,2 , Stacey Martiniano 1,2 , Paul Jedlicka 4 , Jason Weinman 5 and Justin Searns 1,3 1 Department of Pediatrics, University of Colorado School of Medicine, Colorado 2 Department of Pulmonary Medicine, University of Colorado School of Medicine, Colorado 3 Department of Infectious Disease, University of Colorado School of Medicine, Colorado 4 Department of Pathology, University of Colorado School of Medicine, Colorado 5 Department of Radiology, University of Colorado School of Medicine, Colorado