A MAN with thoracic actinomycosis had disseminated lesions. Initial biopsy specimens showed a granulomatous vasculitis and absent sulfur granules. Several cultures were negative. The correct diagnosis was not made for a long period, and the clinical and pathologic findings suggested a form of Wegener's granulomatosis. It was not until repeated biopsy specimens and cultures showed the organism that the diagnosis of actinomycosis was made. This case illustrates the importance of proper and persistent microbiologic techniques.
Report of a Case
A 43-year-old man was referred to the hospital because of a six-month history of coughing, weight loss, hemoptysis, coryza, and nosebleeds. At that time, he had a positive PPD tuberculin test, and the chest roentgenogram showed an infiltrate in the right upper lobe and right lower lobe. He also had fluctuant skin masses on the dorsum of the hands bilaterally and on the right thigh. Clinically, these were thought to represent
Smith LR, Heaton CL. Actinomycosis Presenting as Wegener's Granulomatosis. JAMA. 1978;240(3):247–248. doi:10.1001/jama.1978.03290030065026
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