Case reports in infectious diseases · 2026
Concurrent Hepatic Abscess and Pleural Empyema due to Actinomyces odontolyticus After Recent COVID-19 Infection: A Case Report.
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Dimitrov Dimo, Mitri Jad, Naamani Hind El, Nader Claudia
Аннотация
INTRODUCTION: Actinomycosis is a rare, slow-progressing infection mimicking malignancies by penetrating mucosal barriers and spreading across anatomical planes. While typically affecting the cervicofacial area, it can also involve the thorax and abdomen, with simultaneous hepatic and pulmonary involvement being particularly rare.
CASE DESCRIPTION: We report the case of an 85-year-old woman with chronic kidney disease, diabetes, and multiple dental procedures who developed fever, myalgias, and abdominal pain a few weeks after recovering from COVID-19. Diagnostic workup revealed a liver abscess extending into the right perinephric space and a small pleural effusion. Gram stain of abscess aspirate showed Gram-positive, branching filamentous rods, negative on a modified AFB stain. Cultures grew Actinomyces odontolyticus, differing from the more common A. israelii. Her hospital course was complicated by acute hypoxic respiratory failure, with CT showing an expanded, loculated right pleural effusion. Treatment included prolonged antibiotic therapy and interventional radiology procedures for abscess drainage.
DISCUSSION: This case highlights the diagnostic and therapeutic challenges of hepatic actinomycosis caused by A. odontolyticus, particularly when affecting adjacent structures, such as the diaphragm and lung. The infection may have spread hematogenously to the liver with subsequent transdiaphragmatic extension into the thoracic cavity or, alternatively, may have originated from aspiration-related thoracic infection with secondary extension toward the liver. Typically occurring in immunocompetent individuals, this severe presentation may reflect the combined influence of recent COVID-19 infection, chronic comorbidities, and recent dental procedures. This underscores the need for vigilance in recognizing atypical postviral infections and highlights the need for further research into opportunistic bacterial infections following COVID-19-related immune dysregulation.
CASE DESCRIPTION: We report the case of an 85-year-old woman with chronic kidney disease, diabetes, and multiple dental procedures who developed fever, myalgias, and abdominal pain a few weeks after recovering from COVID-19. Diagnostic workup revealed a liver abscess extending into the right perinephric space and a small pleural effusion. Gram stain of abscess aspirate showed Gram-positive, branching filamentous rods, negative on a modified AFB stain. Cultures grew Actinomyces odontolyticus, differing from the more common A. israelii. Her hospital course was complicated by acute hypoxic respiratory failure, with CT showing an expanded, loculated right pleural effusion. Treatment included prolonged antibiotic therapy and interventional radiology procedures for abscess drainage.
DISCUSSION: This case highlights the diagnostic and therapeutic challenges of hepatic actinomycosis caused by A. odontolyticus, particularly when affecting adjacent structures, such as the diaphragm and lung. The infection may have spread hematogenously to the liver with subsequent transdiaphragmatic extension into the thoracic cavity or, alternatively, may have originated from aspiration-related thoracic infection with secondary extension toward the liver. Typically occurring in immunocompetent individuals, this severe presentation may reflect the combined influence of recent COVID-19 infection, chronic comorbidities, and recent dental procedures. This underscores the need for vigilance in recognizing atypical postviral infections and highlights the need for further research into opportunistic bacterial infections following COVID-19-related immune dysregulation.