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Case Reports
. 2021 Jul 13;14(7):e235883.
doi: 10.1136/bcr-2020-235883.

Primary mammary actinomycosis challenged with penicillin allergy

Josephine B de Leoz  1 , Devi Suravajjala  1 , Hashmi Rafeek  1 , Vani Selvan  2
Affiliations
Case Reports

Primary mammary actinomycosis challenged with penicillin allergy

Josephine B de Leoz et al. BMJ Case Rep. .

Abstract

Actinomycosis is a subacute-to-chronic bacterial infection caused by gram-positive, filamentous, non-acid-fast, facultative anaerobic bacteria. It is a normal commensal bacterium found in the oral cavity and the lower reproductive tract of women. We present a case of primary actinomycosis of the breast. A postmenopausal woman, complicated by penicillin allergy, presented with a left breast lump clinically simulating malignancy. The first line of treatment for actinomycosis is penicillin. Due to a penicillin allergy, the patient was initially treated with doxycycline. However, doxycycline was discontinued due to tremors, and was replaced by clindamycin. The patient had a good clinical response with resolution of the abscess.

Keywords: breast cancer; drugs: infectious diseases; general practice / family medicine; general surgery; ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ultrasound of the left breast. Actinomycosis of the left breast: ultrasound of the left breast, showing a 2.2x2.3 cm irregular hypoechoic areas of the left breast at 11 o’clock with indistinct margins.
Figure 2
Figure 2
Mammogram of the left breast. Actinomycosis of the left breast: mammogram of the left breast, showing an ill-defined asymmetric radiopaque lesion extending from 10:00 to 2:00 o'clock in the left upper breast suspicious for malignancy (BIRADS category 4) but cannot rule out an infectious process.
Figure 3
Figure 3
Ultrasound-guided fine-needle aspiration of the left breast abscess.
Figure 4
Figure 4
Ultrasound of the left breast—recurrence of the mass. Actinomycosis of the left breast: ultrasound of the left breast, showing a 2.7×1.5 cm irregularly marginated fluid collection with surrounding breast edema most consistent with an abscess. 2D, two dimensional ultrasound; CF, color flow mode; AOC, area of concern; TAC1, tissue abberation correction.
Figure 5
Figure 5
Actinomycosis in H&E stain (left) and PAS (right) on higher magnification. PAS, Periodic acid-Schiff stain.
Figure 6
Figure 6
Timeline of disease progression. BI-RADS, Breast Imaging Reporting and Database System; FNAC, fine-needle aspiration and cytology; USG, ultrasound.
See this image and copyright information in PMC

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