Esophageal actinomycosis: a case report and review of the literature

A 37-year-old African-American male with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. An upper gastrointestinal endoscopy had been performed two months previously and esophageal biopsy revealed extensive candidal infection with ulceration. He temporarily responded to fluconazole. Repeat biopsy revealed actinomyces and continued candidal infection. Review of the original biopsy also demonstrated actinomyces in addition to candida. After initial response to therapy with penicillin, he worsened on outpatient therapy and subsequently expired from progression of disease. Lack of compliance may have been contributary. To date, 8 patients with esophageal actinomycosis have been reported, five of whom had AIDS. Of the remaining three, none was otherwise immunocompromised. This is the first report of esophageal actinomycosis occurring as a superinfection of candidal ulceration. We also describe the findings and utility of thoracic CT in this condition and review the literature.