title: Periodontitis-associated septic pulmonary embolism caused by Actinomyces species identified by anaerobic culture of bronchoalveolar lavage fluid: a case report.
abstract: BACKGROUND
  Periodontal disease is a less common but important cause of septic pulmonary embolism (SPE). However, the pathogens causing periodontal disease-associated SPE (PD-SPE) have been poorly understood. Actinomyces species are resident microbiota in the oral cavity. Here we report a case of PD-SPE caused by Actinomyces species, which was identified by anaerobic culture of bronchoalveolar lavage fluid (BAL).
  
  
  METHODS
  A 64-year-old Asian man, complicated with severe chronic periodontitis, was admitted with chest pain and fever. Chest CT revealed multiple bilateral pulmonary nodules located subpleurally. We diagnosed the case as SPE associated with periodontitis. Although blood cultures were negative for the usual 5-day incubation, anaerobic culture of the BAL fluid sample yielded Actinomyces species. Antibacterial therapy alone did not ameliorate the symptoms; however, additional dental treatment, including tooth extraction, promptly did. The patient was discharged 23 days after admission. The 3-month follow-up revealed no recurrence of the symptoms and complete resolution of the lung lesions.
  
  
  CONCLUSIONS
  This case demonstrated that Actinomyces species can cause PD-SPE. Additionally, clinicians should consider performing appropriate anaerobic culture of BAL fluid to identify the pathogen of SPE, and to ordering dental treatment, if necessary, in addition to antibiotics for the initial management of PD-SPE.
authors.affiliation: Department of Internal Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Endo
authors.affiliation: Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan. eikan@med.tohoku.ac.jp.|Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. eikan@med.tohoku.ac.jp.
authors.forename: Eikan
authors.initials: E
authors.lastname: Mishima
authors.affiliation: Department of Internal Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takeuchi
authors.affiliation: Department of Dentistry, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.|Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohi
authors.affiliation: Department of Respiratory Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ishida
authors.affiliation: Department of Respiratory Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Yanai
authors.affiliation: Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Kiyomoto
authors.affiliation: Department of Internal Medicine, Japanese Ishinomaki Red Cross Hospital, Ishinomaki, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Nagasawa
authors.affiliation: Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
mesh_terms: D000190:Actinomyces / Q000472:pathogenicity*; D000196:Actinomycosis / Q000150:complications* / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications* / Q000382:microbiology* / Q000601:surgery; D011655:Pulmonary Embolism / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014081:Tooth Extraction
chemical_list: D000900:Anti-Bacterial Agents