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Picture of the Month—Diagnosis
Arch Pediatr Adolesc Med. 2006;160:1298.
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Denouement and Discussion: Tonsillar Actinomycosis
Tonsillar actinomycosis was diagnosed in an otherwise healthy adolescent girl. Tissue histopathologic examination revealed amorphous fragments composed of slender filaments. Gram stain and Gomori methamine silver fungal stain confirmed the presence of gram-positive bacilli and granules compatible with actinomycosis. Staining for acid-fast bacilli was negative. Diagnostic evaluation was performed to locate the source of the granules. Neck and chest radiographs were normal and sputum cytologic results were negative. Direct laryngobronchoscopy revealed enlarged tonsils with copious amounts of thick particulate material in the crypts of the right tonsil.
She remained symptomatic despite 6 weeks of oral amoxicillin therapy. Subsequently, tonsillectomy was performed, and postoperatively, she stopped coughing up debris and had no further choking spells. She completed 6 months of amoxicillin therapy. She has remained well and has not expectorated any further masses.
Actinomyces species are strictly anaerobic, gram-positive, nonsporulating bacteria that are considered part of the normal flora of the . . . [Full Text of this Article]
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