Oesophageal actinomycosis complicating a pharyngeal pouch

We report a case of actinomycosis complicating a pharyngeal pouch, in an elderly, immuno-competent woman who presented with dysphagia and weight loss. The diagnosis was established histologically, and confirmed by culture which identified Actinomyces meyeri as the pathogenic agent. This fastidious anaerobic to microaerophilic, Gram positive filamentous bacterium is part of the normal flora of the mouth, gastrointestinal tract, and vagina. Oesophageal actinomycosis is considered to be extremely rare and this is the first case in which A. meyeri has been isolated. The inflammation and subsequent mucosal ulceration due to the pharyngeal pouch is considered to be the underlying factor for the development of infection. Our patient responded well to a course of intravenous and oral antibiotic therapy and her clinical symptoms significantly improved. Our case presents some rare features of oesophageal actinomycosis and also demonstrates the importance of considering this diagnosis in symptomatic patients even in the absence of any obvious underlying condition.