3 years ago

Actinomycose pulmonaire. Particularités diagnostiques et thérapeutiques

M. Loukil, I. Khalfallah, K. Bouzaidi, E. Chelbi, H. Ghrairi

Publication date: Available online 30 May 2018

Source: Revue de Pneumologie Clinique

Author(s): M. Loukil, I. Khalfallah, K. Bouzaidi, E. Chelbi, H. Ghrairi

Résumé
Introduction

L’actinomycose est une affection suppurative rare, subaiguë ou chronique due à des bactéries du genre actinomyces.

Observations

Il s’agissait de 4 patients présentant une symptomatologie respiratoire traînante. L’examen clinique était pauvre dans tous les cas. L’exploration tomodensitométrique montrait une masse tissulaire suspecte dans tous les cas. La fibroscopie bronchique montrait une formation bourgeonnante dans 2 cas et était normale dans 2 cas. Toutes les biopsies bronchiques étaient négatives. Devant la symptomatologie traînante, l’altération de l’état général, l’aspect endoscopique et l’aspect scannographique, le diagnostic de néoplasie pulmonaire était suspecté, d’où le recours à un traitement chirurgical à visée diagnostique et thérapeutique. L’examen anatomopathologique de la pièce opératoire était en faveur de l’actinomycose. Le but de ce travail est de rappeler les aspects radiocliniques, histologiques, thérapeutiques et évolutifs ainsi que les difficultés diagnostiques de cette affection.

Conclusion

La présentation radioclinique de l’actinomycose est souvent trompeuse. Une confirmation diagnostique s’impose avant une résection chirurgicale pouvant être inutile.

Summary
Introduction

Actinomycosis is a rare suppurative infection, subacute or chronic caused by bacteria of the genus Actinomyces.

Observations

A case study of 4 patients with prolonged respiratory symptoms. The clinical examination was poor in all cases. The CT-scan showed, in all cases, a suspicious tissue mass. The bronchoscopy diagnosis showed, in 2 cases, a tumor budding and was normal for the 2 other cases. Bronchial biopsies were negative in all cases. Before the prolonged symptomatology, the poor general condition, the endoscopic and the CT aspects; there was a suspect around a pulmonary neoplasia diagnosis, thus raising the need of a surgical treatment for diagnostic and therapeutic purposes. The anatomopathological examination of the resected specimen was in favour of the actinomycosis. The aim of these observations is to draw the attention to the radio-clinical, histological, therapeutic and evolutive aspects as well as the diagnostic difficulties of this condition.

Conclusion

The radio-clinical presentation of the actinomycosis is often misleading, thus a diagnostic confirmation is required before any useless surgical resection.

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