Actinomyces Odontolyticus Cavitary Pneumonia in a Vape Smoker

Document Type

Abstract

Publication Date

5-1-2025

Abstract

Background Actinomyces species are facultative anaerobes that naturally inhabit the human oral cavity, colon, and vagina. Actinomycosis, a rare chronic granulomatous infection, typically arises in immunocompromised individuals. It's classified by the anatomical site involved, with the 3 main subtypes being cervicofacial (60%), abdominal (20%), and pulmonary (15%). Risk factors for pulmonary actinomycosis include poor oral hygiene, aspiration risk, underlying lung disease, and immunocompromise.A recent report by Massey et al. linked marijuana vaping to pulmonary actinomycosis. Here, we describe a case of cavitary pneumonia caused by A. Odontolyticus in an otherwise healthy young woman who underwent a recent dental procedure and does nicotine vaping.Case PresentationWe're presenting a case of a 48-year-old female with a history of obesity, opioid abuse on methadone therapy and a 5-year history of vape smoking who presented to the hospital for an evaluation of dry cough and shortness of breath that started 1 week prior to her presentation. Patient didn't have signs of respiratory distress, was Afebrile and saturating 87% on room air. Chest x-ray showed bibasilar opacities so, a CT angiography of the chest was done showing patchy ground-glass opacification suggestive of pneumonia with a left lower lobe cavitary lesion with air-fluid level suggestive of an abscess. She was started on broad-spectrum antibiotics and underwent bronchoscopy with bronchoalveolar lavage with brush. Culturing the lavage grew a pure Actinomyces Odontolyticus. The patient was started on penicillin V for 3 months. Upon further history taking, the patient stated that she underwent a recent root canal treatment. She denied dental pain and there was no discharge up on examination.DiscussionThis case illustrates a rare instance of pulmonary actinomycosis caused by Actinomyces Odontolyticus in an otherwise healthy young woman following dental work and vape smoking. While it can rarely present as a pulmonary infection in immunocompromised individuals, A. Odontolyticus infection in this patient suggests that a recent dental manipulation and vaping may have facilitated bacterial entry and lung infection.Risk factors are crucial when considering Actinomyces pulmonary involvement because of its propensity to mimic other pulmonary inflammatory or neoplastic conditions. While the treatment is readily available, the diagnosis remains a challenge with a correct diagnosis on initial presentation being as low as 4%. While smoking is a known risk factor for respiratory infections this case adds to emerging evidence that vaping may similarly predispose healthy individuals to commensal oral flora causing pulmonary infections.

Publication Title

American Journal of Respiratory and Critical Care Medicine

Volume

211

Issue

Abstracts

First Page

A6778

Last Page

A6778

Comments

American Thoracic Society International Conference, ATS 2025 held 2025-05-16 to 2025-05-21 in San Francisco, CA

Link to Full Text

Open Access

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