Date Published: July 23, 2019
Publisher: Wolters Kluwer
Author(s): Ali Alshati, Leslie Appleton, Jacob T. Maddux, Mays Almohammedawi, Benjamin Dangerfield.
Esophageal actinomycosis is a rare type of esophageal infection, with only approximately 24 cases previously reported in the United States. Most of these cases were described as erosions or ulcers when examined endoscopically. We present a 47-year-old woman who presented with dysphagia. Endoscopy showed a lower esophageal fungating mass, mimicking a malignant mass. Although there was a high suspicion of esophageal carcinoma, biopsy results showed esophageal actinomyces infection.
Swallowing-associated problems affect 1 in 25 persons in the United States, and the prevalence increases with age. The estimated prevalence of dysphagia in patients older than 50 years is up to 22%.1 Well-known causes of obstructive esophageal dysphagia include esophageal stricture, esophageal carcinoma, eosinophilic esophagitis, and esophageal webs and rings. Upper endoscopy is an effective and essential tool for the evaluation of dysphagia, especially in men older than 40 years and/or when there is weight loss. Abnormal findings can be recognized by upper endoscopy in 70% of the patients present with dysphagia.1
A 47-year-old woman presented with progressive esophageal dysphagia. She has a past medical history significant for gastroesophageal reflux disease complicated by esophageal stricture status after dilation, type 2 diabetes mellitus, and chronic immunosuppressive therapy after a kidney-pancreas transplant about 7 years ago. Her dysphagia had been worsening lately and was associated with epigastric abdominal pain and weight loss. The patient denied heavy alcohol consumption or tobacco use. She had multiple esophageal dilations; the last was by balloon dilation about 3 months before her presentation. Physical examination was only significant for mild-epigastric tenderness.
Actinomyces are facultative anaerobic, Gram-positive bacilli. They commensally live within the oral cavity and gastrointestinal (GI) tract. They are slow-growing bacteria that can cause hard, pus-filled abscesses in the affected tissue.
Author contributions: A. Alshati wrote the manuscript and is article guarantor. L. Appleton, JT Maddux, and B. Dangerfield revised the manuscript. M. Almohammedawi edited the manuscript.