title: [Thoracic chest wall fistula formation].
abstract: Thoracic actinomycosis is a suppurative infection which can be difficult to diagnose as its presentation may mimic cancer or tuberculosis. We report a new case of thoracic actinomycosis in a 35-year-old man who presented with thoracic symptoms associated to a productive parietal fistula. Imaging exploration revealed an opacity of the right ventroapical segment with parietal infiltration. A bilobectomy and a parietectomy were performed. The anatomopathologic diagnosis actinomycosis was confirmed. The patient was first put on a treatment of azathioprine 1g daily during two weeks, then switched to a combination with Vibramycin 100 mg twice a day during 17 months, The evolution was marked by the persistence of productive fistulae, which were treated surgically, and resistance to the initial treatment leading to a switch to Augmentin 3 g daily during 25 days. The patient experienced clinical improvement with a follow up of 18 months than was lost to follow-up.
authors.affiliation: Service d'anatomie et de cytologie pathologiques, département d'anatomopathologie, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Ayadi-Kaddour
authors.forename: M
authors.initials: M
authors.lastname: Mlika
authors.forename: A
authors.initials: A
authors.lastname: Marghli
authors.forename: E
authors.initials: E
authors.lastname: Braham
authors.forename: T
authors.initials: T
authors.lastname: Kilani
authors.forename: F
authors.initials: F
authors.lastname: El Mezni
mesh_terms: D000196:Actinomycosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D017577:Cutaneous Fistula / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D004318:Doxycycline / Q000627:therapeutic use; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009336:Necrosis; D010400:Penicillin G / Q000627:therapeutic use; D035441:Thoracic Wall; D013909:Thorax; D016896:Treatment Outcome
chemical_list: D001379:Azathioprine; D004318:Doxycycline; D010400:Penicillin G