Akhlaghi, Mahmood.

Daie Ghazvini, Roshanak.

shahrekord university of medical scinces

Clinical Presentation of Primary Actinomycosis of theBreastMahmood Akhlaghi, MD and Roshanak Daie Ghazvini, PhDDepartment of Anesthesiology, Critical Care and Pain Service, Shahrekord University of MedicalSciences, Shahrekord, IranPrimary actinomycosis of the breast was revealedin a young 30-year old woman without any his-tory of breast disease, complaining of sudden painfuland swollen left breast for a few days. Bilateral lowdose mammogram demonstrated bilateral dense breastwith asymmetrical increased density of the left breast(Fig. 1). Severe arthralgia in all her joints especiallyknee joints as well as severe more painful breast werethe major complains after open biopsy of her leftbreast, and postoperative sonography showed multipleheterogeneous necrotic foci (Fig. 2). Moreover, collec-Figure 1. Mediolateral and craniocaudal mammogram of primarybreast actinomycosis shows augmented density of the left breast(L1,L2) compared with contralateral breast (R1,R2).Figure 2. Sonography of primary left breast actinomycosis withnecrotic foci.Figure 3. Breast lesions due to Actinomyces israelii presentedfistulas draining to the skin.Address correspondence and reprint requests to: Dr. Mahmood Akh-laghi, Department of Anesthesiology, Critical Care and Pain Service, Shah-rekord University of Medical Sciences, Kashani Street, Shahrekord, Iran8815713471, or e-mail: akhlaghi@skums.ac.ir or akhlaghi236@yahoo.comª 2008 Wiley Periodicals, Inc., 1075-122X/08The Breast Journal, Volume 15 Number 1, 2009 102–103102 • akhlaghi and ghazvinition fistulas draining to the skin were seen on appear-ance (Fig. 3). Finally, the diagnosis of breast actinomy-cosis was confirmed by direct examination onaspirated material with 10% KOH, Gram and Kin-youn stained smear and anaerobic culture (Figs. 4 and5). After confirmation of breast actinomycosis, thepatient responded well to the treatment with erythro-mycin (800 mg 4 times a day) for 6 months and isdoing well.Breast actinomycosis is very rare and only a fewcases have been reported so far. The most importantpoint in this case that is different from other reportedstudies is particular clinical presentation such asarthralgia which guided our thought towards theprobable link between the disease and patient’simmune response. Clinicians should be aware of suchpresentation so as to prevent misdiagnosis.Breast Cancer and Multiple Myeloma at InitialPresentationAli Al-Said Ali, MRCS, KSB,* Ibtisam Al-Bader, FRCSC,* Fatma Al-Ali, MD,Abdel Hamid Elgazzar, ABNM, and Salah Fayez, MRCP§*Department of General Surgery, Mubarak Al-Kabeer Hospital, Kuwait; Department ofHaematology, Mubarak Al-Kabeer Hospital, Kuwait; Department of Nuclear Medicine, Faculty ofMedicine, Kuwait University, Kuwait; and §Department of Surgical Oncology, Kuwait Cancer ControlCentre, KuwaitA 56-year-old obese woman presented to the surgi-cal outpatient clinic with a right breast mass of1 year duration. The patient was complaining ofleft thigh pain for the last 6 months prior to herpresentation. Right breast examination revealed peaud’ orange with a 3 · 3 cm mass. The rest of her exam-ination was normal except for tenderness over the leftlower thigh. ESR was raised at 72 mm ⁄hour. Heralkaline phosphatase was elevated at 155 IU ⁄L (nor-mal 26–88).The patient had a high total protein of84 g ⁄L (normal 63–80) with normal serum calciumlevels. CA 15.3 was normal at19.5 U ⁄mL (normal<40).Ultrasound and mammogram of both breastsrevealed a 3.7 · 2 cm dense lobulated lesion withspiculated margins extending from the mass up to theretro-areolar region with skin thickening (Fig. 1). AFigure 4. Branch filaments of Actinomyces israelii. Gram stained(·1000).Figure 5. Colonies of Actinomyces israelii on BHIB at 37C.Address correspondence and reprint requests to: Dr. Ibtisam Al-Bader,Department of Surgery, Mubarak Al-Kabeer Hospital, P.O. Box 43787,Postal Code 35052, Hawally, Kuwait, or e-mail: albader_ib@hotmail.comª 2008 Wiley Periodicals, Inc., 1075-122X/08The Breast Journal, Volume 15 Number 1, 2009 103–105Breast Cancer and Multiple Myeloma • 103

Clinical Presentation of Primary Actinomycosis of the Breast

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shahrekord university of medical scinces