Abdominal actinomycosis

Hemoptysis as an early symptom of abdominal actinomycosis with thoracic extension ten years after cholecystectomy with retained gallstone

BACKGROUND

Thoracoabdominal actinomycosis is rare, especially in the context of readily available medical facilities.

METHODS

Case report and review of the literature.

CASE REPORT

A 54-year-old male patient was admitted because of hemoptysis and a pulmonary infiltrate in the left lower lobe. His history was unremarkable except for chronic gastritis and an elective laparoscopic cholecystectomy performed 10 years earlier. Following persistent hemoptysis, elevated inflammatory markers, and a non-revealing bronchoscopy, a computed tomography scan of the thorax and upper abdomen revealed a tumor in the upper part of the left kidney spreading directly to the adjacent diaphragm and left lower lobe. Laparotomy revealed a granulomatous mass containing a gallstone, as well as orange granular content. The treatment involved surgical removal of the mass, splenectomy, excision of the infiltrated part of the left hemidiaphragm, and decortication of the left lower lobe. Because of a prolonged post-operative low-grade fever and radiologically confirmed encapsulation in the lingula, the patient was given ceftriaxone. Repeat bronchoscopy revealed Actinomyces meyeri. The initial antibiotic therapy was replaced with amoxicillin-clavulanic acid, after which the patient's health improved.

CONCLUSION

Actinomycosis is still a highly intriguing disease, as initial symptoms often mislead clinicians. It is important to consider the disease whenever we are challenged diagnostically or when risk factors are present.

Primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade

Cardiac tamponade constitutes an exceptional form of actinomycosis. We describe a case of primary hepatic actinomycosis presenting as purulent pericarditis with cardiac tamponade in a 20-year-old patient with previous esophagectomy and colonic interposition, successfully managed by computed tomography-guided percutaneous drainage and a prolonged course of antibiotic treatment. Actinomyces israelii was identified in the pericardial fluid by 16S rRNA gene sequencing. The literature on the simultaneous presentation of cardiac and hepatic actinomycosis is reviewed.

Infectious causes of appendicitis

The pathologic spectrum of the inflamed appendix encompasses a wide range of infectious entities, some with specific histologic findings, and others with nonspecific findings that may require an extensive diagnostic evaluation. The appendix is exclusively involved in some of these disorders, and in others may be involved through extension from other areas of the gastrointestinal tract. This review discusses the pathologic features of bacterial, viral, fungal, and parasitic infections affecting the appendix, including adenovirus; cytomegalovirus; Yersinia, Actinomyces, Mycobacterium, or Histoplasma species; Enterobius vermicularis; schistosomiasis; and Strongyloides stercoralis. Pertinent ancillary diagnostic techniques and the clinical context and significance of the various infections are also discussed.

Surgical treatment for abdominal actinomycosis: A report of two cases

Since actinomycosis sometimes causes an abdominal tumor which mimics malignancy, treatment strategy varies from case to case. We herein report two cases which were treated with a combination of antibiotics and surgical intervention. Both patients presented with an intra-abdominal tumor lesion mimicking malignant disease after an appendectomy for acute appendicitis. Case 1 received surgical extirpation of the abdominal tumor in the liver and kidney twice since the clinical diagnosis of actinomycosis was not made. In contrast, case 2 was successfully treated by a combination of antibiotics and laparoscopic surgery following the experience of case 1. When a high probability diagnosis can be made, a laparoscopic approach is a useful and effective option to treat this condition.

Liver abscess due to Actinomyces odontolyticus in an immunocompetent patient

Liver abscess caused by Actinomyces odontolyticus is rarely reported. We report an immunocompetent patient who developed A. odontolyticus liver abscess, and was successfully treated with antibiotics for 6 weeks and abscess drainage. The isolate could not be identified accurately by one commercial biochemical method and was documented to species level by partial sequencing analysis of 16S rRNA genes.

Case report: actinomycosis of the appendix--an unusual cause of acute appendicitis in children

Abdominal actinomycosis in children is a rare disease, which is occasionally found on histologic examination after an operation for acute appendicitis. Because of its nonspecific clinical and radiological signs and symptoms and low prevalence, the diagnosis is hardly ever made before the patient undergoes an operation and tissue is available for pathologic evaluation. When the diagnosis is made, the patient should be treated with the appropriate long-term antibiotics. With antibiotic therapy, the prognosis is favorable. We describe a 13-year-old girl who presented with acute appendicitis and was found to have abdominal actinomycosis after undergoing open appendectomy, which was treated successfully with penicillin and piperacillin-tazobactam.

Isolated abdominal wall actinomycosis associated with an intrauterine contraceptive device: a case report and review of the relevant literature

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient.

Actinomycosis of the colon with invasion of the abdominal wall: An uncommon presentation of a colonic tumour

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, however, three main clinical types of involvement are recognized including cervico-facial, thoracic and abdominal actinomycosis.Herein, we present the case of a 79-year-old male patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Pathologic examination confirmed this as a case of abdominal actinomycosis. This diagnosis should always be included in the differential diagnosis of patients who present with an infiltrative abdominal mass.