Gastroenterol Res
Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Case Report

Volume 3, Number 4, August 2010, pages 173-174


Dermatophilus Congolensis Infection of the Esophagus

Vivek S. Ramanathana, e, Alexander W. Jahngb, Boris Shlopovc, Binh V. Phamd

aDepartment of Internal Medicine, St. Mary Medical Center, Long Beach, California, USA
bDepartment of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
cDepartment of Pathology, Harbor-UCLA Medical Center, Torrance, California, USA
dDivision of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
eCorresponding author: 1050 Linden Ave, St. Mary Medical Center, Long Beach, California, USA. 90813

Manuscript accepted for publication July 8, 2010
Short title: D. Congolensis Infection of Esophagus
doi: https://doi.org/10.4021/gr216w

Abstract▴Top 

We report the first case of Dermatophilus congolensis infection of the human esophagus. We demonstrate initial endoscopic diagnosis, progression and then spontaneous resolution of D. congolensis infection, once the patient's occupational exposure had ceased.

Keywords: Dermatophilus; Congolensis; Esophagitis

Case Report▴Top 

A 53-year-old female presented with two year history of chronic epigastric pain and ‘heart burn’. The review of systems was negative. The patient worked as a nail technician in close proximity to a horse race track, but she herself did not have direct contact with the animals. Physical examination and the labs were within normal limits.

Initial upper endoscopy showed slight granularity in the distal esophagus and superficial erosions in the antrum. Biopsy showed intestinal metaplasia and reflux esophagitis. Helicobacter pylori were negative. Six months later gastric mapping was performed to evaluate the intestinal metaplasia and showed acute-on-chronic erosive gastritis, but no dysplasia. Esophagoscopy revealed numerous 1-2 mm white plaques that was adherent from mid-esophagus down to the gastroesophageal junction (Fig. A). Brushings for cytology with Papanicolaou stain were done to rule out Candida, but instead showed septated and filamentous hyphae and coccoid forms of bacteria consistent with Dermatophilus congolensis (Fig. B). Candida was not cultured.

Figure A.
Click for large image
Figure A. Esophagoscopy revealed numerous 1-2 mm white plaques that was adherent from mid-esophagus down to the gastroesophageal junction.

Figure B.
Click for large image
Figure B. Brushings for cytology with Papanicolaou stain were done to rule out Candida, but instead showed septated and filamentous hyphae and coccoid forms of bacteria consistent with Dermatophilus congolensis.

Erroneously, the patient was then started on triple therapy for H. pylori by her primary care doctor which resulted in rapid and complete resolution of symptoms. Repeat endoscopy one month later showed progression of white plaques to involve the entire esophagus diffusely and was again consistent with D. congolensis. However, the patient continued to be asymptomatic but was unfortunately lost to follow-up before further recommendations could be made. Care was re-established one year later, six months after she quit her job. Final endoscopy showed complete resolution of white plaques despite lack of further intervention (Fig. C).

Figure C.
Click for large image
Figure C. Final endoscopy showed complete resolution of white plaques despite lack of further intervention.
Discussion▴Top 

This is the first reported case of D. congolensis infection of the human esophagus. The only other reported case of human mucosal infection presented as leukoplakia [1]. D. congolensis is a gram positive, facultative anaerobe in the order Actinomycetales [2, 3]. It is a well known skin pathogen in animals that causes disease known as dermatophilosis; it causes proliferative and exudative epidermatitis. The most common mode of infection is thought to occur via direct transfer, possibly through areas minor trauma, or indirectly via ectoparasites. The human infection is rarer, and occurs in people with direct exposure to infected animals. It is generally self-limited with gradual and spontaneous resolution, though recurrent and chronic nodular forms have been noted. It is reported to be sensitive to variety of antibiotics in vitro, including to tetracycline, penicillin and macrolides. Treatment can be attempted but is often unsuccessful for two reasons; topical antibiotics fail to reach the deeper epidermis, which is further compromised by the exudative nature of the infection and systemic antibiotics fail because of the relative avascularity of the upper epidermal layer.

In this case report, we demonstrate endoscopic diagnosis, progression and spontaneous resolution of D. congolensis infection of the esophagus that was dissociated symptomatically. It is hypothesized that the infection occurred as part of occupational exposure, possibly through direct inhalation and swallowing of the contaminated air or fragmented nails of horse handlers at the race track, who frequented her place of work. The existing acid reflux with injured esophageal epithelium may have facilitated the inoculation and progression to infection. The progression of infection despite antibiotic therapy for H. pylori reflects the difficulty in delivering antibiotics to the site of infection. The spontaneous resolution after she quit her job may reflect the necessity for repeat exposure in maintaining the ongoing infection, or simply its natural cycle in humans.

Disclosures

None


References▴Top 
  1. Bunker ML, Chewning L, Wang SE, Gordon MA. Dermatophilus congolensis and “hairy” leukoplakia. Am J Clin Pathol. 1988;89(5):683-687.
    pubmed
  2. Burd EM, Juzych LA, Rudrik JT, Habib F. Pustular dermatitis caused by Dermatophilus congolensis. J Clin Microbiol. 2007;45(5):1655-1658.
    pubmed doi
  3. Zaria LT. Dermatophilus congolensis infection (Dermatophilosis) in animals and man! An update. Comp Immunol Microbiol Infect Dis. 1993;16(3):179-222.
    pubmed doi


This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Gastroenterology Research is published by Elmer Press Inc.

 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Gastroenterology Research, bimonthly, ISSN 1918-2805 (print), 1918-2813 (online), published by Elmer Press Inc.             
The content of this site is intended for health care professionals.

This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.gastrores.org   editorial contact: editor@gastrores.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.