Abstract
Actinomycosis of the spine with spinal cord compression is rare. Only 22 cases are
reported in the literature. The authors describe a remarkable case of a large lesion
leading to bony destruction and spinal cord compression in the cervicothoracic junction
with a large intrathoracic extension, which was considered to be a metastatic pulmonary
disease but turned out to be actinomycosis.
Clinical Presentation A 55-year-old man presented with acute tetraparesis. Magnetic resonance imaging (MRI)
and computed tomography (CT) imaging showed vertebral body collapse of T1 and partially
C7 with spinal cord compression as well as a mass in the right upper lobe with multiple
intrapulmonary nodules. Moreover, dorsal elements (laminae and spinous process) were
also involved and partially destructed. Differential diagnosis favored metastatic
pulmonary disease.
Intervention Decompression surgery was performed by anterior corpectomy of T1, stabilization with
an expandable titanium cage and additional anterior plate C7–T2. Histology revealed
typical sulfur granules. Microbiology exams were positive for Actinobacillus actinomycetemcomitans. There was no proof of malignancy in thoracic biopsy in the late diagnostic work-up.
To prevent instrumentation failure, an external immobilization (halo fixation) was
applied until complete fusion was documented in CT during the postoperative course.
After an 11-month course of ampicillin/sulbactam, there was complete resolution of
the intrapulmonary and spinal pathology.
Conclusion Thoracic actinomycosis with spinal involvement is a rare disease. Therefore, diagnosis
may be difficult. Surgical intervention, correct diagnosis, and specific long-term
antibiotic treatment resulted in favorable outcome.
Keywords
actinomycosis - Actinobacillus actinomycetemcomitans - osteomyelitis - spinal - pulmonary
