Abstract: FR-PO789
An Uncommon Presentation of Esophageal Actinomycosis in a Patient with Recent Kidney Transplant
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Ferreira, Joao Paulo Senna, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
- Kassar, Liliana M L, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
- Carvalho Barros Sousa, Felipe, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
- Moreira, Raquel Megale, Universidade de Sao Paulo, Sao Paulo, Brazil
Introduction
Actinomycosis is a rare granulomatous disease, caused by a gram positive anaerobic bacterium, which inhabits the gastrointestinal tract and oral cavity in a commensal manner, but can cause an infectious process by invading injured tissue. Actinomyces israelii is the main human pathogen. The most common site of involvement is cervicofacial region with formation of abscesses and granulomas, followed by abdominal and thoracic involvement.
Case Description
A 33-years-old male, three months after kidney transplant from deceased donor, zero HLA mismatches, non-sensitized, started with fever and oral ulcers three days prior admission to the hospital. The patient's immunossupression was tacrolimus and mycophenolate. He had been on treatment with Valganciclocir for 20 days due to asymptomatic cytomegaly with positive antigenemia. The patient was hospitalized and started on empirical IV Ganciclovir due to possible cytomegalovirus (CMV) disease. Despite the treatment, he maintained fever episodes and experienced worsening of oral ulcers, and onset of odynophagia, with the presence of esophageal ulcers in the upper digestive endoscopy. Biopsy of esophageal ulcers was performed with the presence of gram-positive colonies and Actinomyces spp. The patient was treated with IV ceftriaxone, and then oral amoxicillin for 4 months with clinical improvement.
Discussion
The case reported above is a rare presentation of Actinomycosis, a disease with low prevalence and difficult diagnosis. The occurrence of oral and esophageal ulcers is uncommon with few cases reported. Main clinical forms comprise cervicofacial features with the occurrence of chronic cutaneous nodules and emergence of gastrointestinal tumors, usually in the ileocecal region, presenting with abdominal pain, weight-loss and weakness. In this case, the diagnosis was challenging due to a large number of possible infections such as herpes simplex, CMV, oral moniliasis, among others, especially in the first 6 months after kidney transplant.