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This 50-year-old woman presented with a one-year history of dyspnea on exertion and a two-week history of a painful, swollenright breast. On examination, she had a tender, warm right breast and several draining sinuses in and near her sternum (left image). Chest radiograph showedmiliary lesions throughout both lungs. Contrast material injected into a sinus opening demonstrated irregular tracts and cavities in the right breast and chestwall (right image).
The clinical findings suggested tuberculosis versus actinomycosis. Incision and drainage of the right breast abscess showed pocketsof pus, but acid fast and fungal stains were negative and cultures grew no organisms. Open lung biopsy, however, showed microabscesses containing sulfurgranules. Cultures again were sterile and stains showed no pathogens. Nevertheless, the combination of sulfur granules and draining sinuses pointedstrongly to actinomycosis. Accordingly, the patient received high doses of penicillin intravenously for six weeks, after which time her sinuses had closed,the breast abscess had healed, and the lung lesions had all but disappeared.
This case may be only the second reported example of miliary lung lesions caused by actinomycosis. It also joins only a handful ofreported cases of actinomycotic breast abscess.
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