PMC7677701_01
A) Pre-therapeutic CT-scan revealing a peripherally enhanced fluid-attenuation within the left lower lobe of the lung, extending to the subdiaphragmatic space, reaching spleen and left kidney, and concluded at the left flank (arrows). B) Abscess drainage revealing purulent discharge with "sulfur granules". C) Histopathological examination I: Characteristic histological presentation of Actinomycosis with actinomycotic granules composed of radiating filaments with a dense granular core, surrounded by inflammatory cells composed of a mixture of neutrophils and eosinophils (hematoxylin and eosin (H&E) staining, magnification 100x). D) Histopathological examination II: Periodic Acid-Schiff (PAS) reaction confirms consistency with Actinomyces colonies ('sulfur granules'; magnification 100x). E) Histopathological examination III: A cluster of Actinomyces visualized by Grocott-Gomori Methenamine Silver stain (GMS; magnification 100x). F) Post-therapeutic MRI after one month (arrows indicating the lesion). G) Post-therapeutic MRI after three month (arrows indicating the shrinking lesion). H) Post-therapeutic MRI after six month (absent arrows reflecting the vanished lesion).
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Finally, a CT-scan of the thoracoabdominal region performed in January revealed a peripherally enhancing fluid-attenuation within the left lower lobe of the lung, extending to the subdiaphragmatic space, reaching spleen and left kidney, and concluded at the site of a meanwhile newly formed skin swelling at the left flank (Fig. 1A). The abscess drainage revealed a purulent discharge with sulfur granules (Fig. 1B). Actinomycosis-typical luminous strangles ubiquitously (Fig. 1C-E). Follow-up examinations with a time range of one, three and six month showed a complete resolution of the lesion (Fig. 1F-H).