Letter to the Editor
Pleural Effusion Secondary to Actinomyces Infection as a Late Complication of Laparoscopic Cholecystectomy
Derrame pleural secundario a infección por Actinomyces como complicación tardía de una colecistectomía laparoscópica
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=> array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Francisco" "apellidos" => "López-Medrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Lalueza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Fernando" "apellidos" => "Granados Caballero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Victoria" "apellidos" => "Villena Garrido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural secundario a infección por <span class="elsevierStyleItalic">Actinomyces</span> como complicación tardía de una colecistectomía laparoscópica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 695 "Ancho" => 1401 "Tamanyo" => 126476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Image of the lesion in the lateral region of the right hemithorax. (B) Chest CT slice showing thickening of the pleura of the right posterolateral costophrenic angle with a hypodense area inside, with extrapleural fat involvement, muscle thickening and pleural effusion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cases of intra-abdominal actinomycosis have been described years after cholecystectomy, although it is a rare complication. Due to the slow growth of <span class="elsevierStyleItalic">Actinomyces</span>, symptoms can present months or even years after surgery.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 71-year-old patient who underwent delayed laparoscopic cholecystectomy for acute cholecystitis. Four years later, he presented with dyspnea, cough, asthenia and pleuritic pain in the right hemithorax. On physical examination he was found to have a hard, painful swelling on the lateral region of the right hemithorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), with absent breath sounds. Acute phase reactants were elevated, and the chest radiograph showed right pleural effusion. Computed tomography (CT) revealed thickening of the pleura of the right posterolateral costophrenic angle (2.5-cm in thickness) and a hypodense area inside with extrapleural fat involvement, muscle thickening and pleural effusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Thoracocentesis was performed and a fluid consistent with an exudate with predominantly polymorphonuclear cells was obtained, which later became mononuclear cell-predominant. Microbiology and cytology were negative. Needle biopsy of the pleural thickening reported an inflamed abscess. Ultrasound of the rib region showed a 3-cm hypoechoic mass, with multiple echoes, consistent with an abscess. This was aspirated and purulent matter was extracted; subsequent culture revealed <span class="elsevierStyleItalic">Actinomyces israelii</span> and <span class="elsevierStyleItalic">Escherichia coli</span>. From that time, the patient presented a chest wall fistula. Intravenous (i.v.) amoxicillin/clavulanic acid treatment was started for 14 days, followed by a further 4 weeks of i.v. penicillin. After 6 weeks of i.v. antibiotic, clinical improvement was observed and the fistula closed. Oral amoxicillin was continued until the patient had completed 12 months of treatment. A follow-up CT scan performed after the patient had been on antibiotics for 5 months showed a reduction in the effusion, with no changes in the pleural thickening.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A. israelii</span> inhabits the oral cavity and upper gastrointestinal tract. Infection can occur when the mucosal barrier is damaged due to endoscopic manipulation, surgery or immunosuppression. Sulfur granules are characteristic on histological examination, but definitive diagnosis is made with microbiological isolation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The infection is usually found in middle-aged men with poor dental hygiene, and is most often located in the cervicofacial area (50%), followed by the abdomen (20%) and chest (15%–20%).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most common cause of chest involvement is aspiration of secretions,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and it can present as empyema, pneumonia that progresses to cavitation, and pericardial or diaphragmatic involvement.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Symptoms are variable and non-specific, and the patient may be asymptomatic. Acute phase reactants are generally elevated.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Initial treatment is i.v., with maximum doses for 4–6 weeks followed by oral treatment for a further 6 to 12 months. Penicillin is the drug of choice, although tetracycline, erythromycin or clindamycin may be also used in patients who are allergic to penicillin. Chest involvement usually requires more prolonged treatment than involvement at any other level. There are specific indications for surgery; as this alone is not curative, it must always be combined with prolonged high-dose antibiotic treatment.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">When diagnosed and treated promptly, the prognosis is good, with low mortality.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Thus, pleural effusion with chest wall involvement in a patient with a history of laparoscopic cholecystectomy could be secondary to abdominal infection by <span class="elsevierStyleItalic">Actinomyces</span>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz Campos RM, López-Medrano F, Lalueza A, Granados Caballero F, Villena Garrido V. Derrame pleural secundario a infección por <span class="elsevierStyleItalic">Actinomyces</span> como complicación tardía de una colecistectomía laparoscópica. Arch Bronconeumol. 2015;51:419–420.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 695 "Ancho" => 1401 "Tamanyo" => 126476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Image of the lesion in the lateral region of the right hemithorax. (B) Chest CT slice showing thickening of the pleura of the right posterolateral costophrenic angle with a hypodense area inside, with extrapleural fat involvement, muscle thickening and pleural effusion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intra-abdominal actinomycosis 11 years after spilled gallstones at the time of laparoscopic cholecystectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Stupak" 1 => "S. Cohen" 2 => "F. Kasmin" 3 => "Y. Lee" 4 => "J.H. 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Benítez Domenech" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "153" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11900696" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary actinomycosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.V. Mabeza" 1 => "J. MacFarlane" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2003" "volumen" => "21" "paginaInicial" => "545" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12662015" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000008/v2_201511200100/S157921291500169X/v2_201511200100/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000008/v2_201511200100/S157921291500169X/v2_201511200100/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500169X?idApp=UINPBA00003Z" ]
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| 2024 July | 40 | 23 | 63 |
| 2024 June | 55 | 28 | 83 |
| 2024 May | 78 | 28 | 106 |
| 2024 April | 33 | 28 | 61 |
| 2024 March | 38 | 26 | 64 |
| 2024 February | 20 | 15 | 35 |
| 2023 March | 8 | 6 | 14 |
| 2023 February | 43 | 19 | 62 |
| 2023 January | 37 | 34 | 71 |
| 2022 December | 43 | 38 | 81 |
| 2022 November | 63 | 31 | 94 |
| 2022 October | 51 | 43 | 94 |
| 2022 September | 47 | 47 | 94 |
| 2022 August | 50 | 41 | 91 |
| 2022 July | 39 | 44 | 83 |
| 2022 June | 39 | 39 | 78 |
| 2022 May | 44 | 42 | 86 |
| 2022 April | 51 | 35 | 86 |
| 2022 March | 64 | 35 | 99 |
| 2022 February | 57 | 38 | 95 |
| 2022 January | 38 | 36 | 74 |
| 2021 December | 414 | 42 | 456 |
| 2021 November | 42 | 46 | 88 |
| 2021 October | 39 | 32 | 71 |
| 2021 September | 35 | 48 | 83 |
| 2021 August | 36 | 41 | 77 |
| 2021 July | 60 | 40 | 100 |
| 2021 June | 63 | 40 | 103 |
| 2021 May | 33 | 24 | 57 |
| 2021 April | 96 | 63 | 159 |
| 2021 March | 82 | 26 | 108 |
| 2021 February | 31 | 22 | 53 |
| 2021 January | 45 | 16 | 61 |
| 2020 December | 39 | 21 | 60 |
| 2020 November | 48 | 21 | 69 |
| 2020 October | 46 | 18 | 64 |
| 2020 September | 32 | 8 | 40 |
| 2020 August | 50 | 20 | 70 |
| 2020 July | 54 | 38 | 92 |
| 2020 June | 52 | 20 | 72 |
| 2020 May | 59 | 21 | 80 |
| 2020 April | 42 | 23 | 65 |
| 2020 March | 49 | 14 | 63 |
| 2020 February | 48 | 25 | 73 |
| 2020 January | 43 | 12 | 55 |
| 2019 December | 34 | 24 | 58 |
| 2019 November | 41 | 19 | 60 |
| 2019 October | 27 | 5 | 32 |
| 2019 September | 35 | 19 | 54 |
| 2019 August | 36 | 15 | 51 |
| 2019 July | 30 | 32 | 62 |
| 2019 June | 39 | 21 | 60 |
| 2019 May | 40 | 13 | 53 |
| 2019 April | 45 | 24 | 69 |
| 2019 March | 36 | 20 | 56 |
| 2019 February | 25 | 18 | 43 |
| 2019 January | 41 | 15 | 56 |
| 2018 December | 35 | 15 | 50 |
| 2018 November | 49 | 24 | 73 |
| 2018 October | 89 | 17 | 106 |
| 2018 September | 28 | 14 | 42 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 38 | 5 | 43 |
| 2018 March | 23 | 6 | 29 |
| 2018 February | 19 | 5 | 24 |
| 2018 January | 30 | 5 | 35 |
| 2017 December | 33 | 7 | 40 |
| 2017 November | 23 | 3 | 26 |
| 2017 October | 27 | 13 | 40 |
| 2017 September | 30 | 6 | 36 |
| 2017 August | 35 | 9 | 44 |
| 2017 July | 22 | 7 | 29 |
| 2017 June | 47 | 10 | 57 |
| 2017 May | 30 | 6 | 36 |
| 2017 April | 18 | 5 | 23 |
| 2017 March | 23 | 6 | 29 |
| 2017 February | 11 | 2 | 13 |
| 2017 January | 17 | 1 | 18 |
| 2016 December | 36 | 7 | 43 |
| 2016 November | 57 | 10 | 67 |
| 2016 October | 43 | 14 | 57 |
| 2016 September | 45 | 16 | 61 |
| 2016 August | 42 | 18 | 60 |
| 2016 July | 28 | 9 | 37 |
| 2016 March | 3 | 0 | 3 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 0 | 2 | 2 |
Show all
