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Gao Y, Jhamb S, Hayler R, Trickett C, Kwok A. Actinomyces as a rare cause of appendicitis: a case report. J Surg Case Rep 2024; 2024:rjae195. [PMID: 38572291 PMCID: PMC10984727 DOI: 10.1093/jscr/rjae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%.
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Affiliation(s)
- Yijun Gao
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Shaurya Jhamb
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, St George Public Hospital, Gray Street, Kogarah 2217, NSW, Australia
| | - Chloe Trickett
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Allan Kwok
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
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2
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Ruaux E, VanBuren WM, Nougaret S, Gavrel M, Charlot M, Grangeon F, Bolze PA, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T2-hypointense lesions. Insights Imaging 2024; 15:20. [PMID: 38267633 PMCID: PMC10808434 DOI: 10.1186/s13244-023-01588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/27/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a common crippling disease in women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While its sensitivity, especially in deep infiltrating endometriosis, is superior to that of ultrasonography, many sources of false-positive results exist, leading to a lack of specificity. Hypointense lesions or pseudo-lesions on T2-weighted images include anatomical variants, fibrous connective tissues, benign and malignant tumors, feces, surgical materials, and post treatment scars which may mimic deep pelvic infiltrating endometriosis. False positives can have a major impact on patient management, from diagnosis to medical or surgical treatment. This educational review aims to help the radiologist acknowledge MRI criteria, pitfalls, and the differential diagnosis of deep pelvic infiltrating endometriosis to reduce false-positive results. Critical relevance statement MRI in deep infiltrating endometriosis has a 23% false-positive rate, leading to misdiagnosis. T2-hypointense lesions primarily result from anatomical variations, fibrous connective tissue, benign and malignant tumors, feces, surgical material, and post-treatment scars. Key points • MRI in DIE has a 23% false-positive rate, leading to potential misdiagnosis.• Anatomical variations, fibrous connective tissues, neoplasms, and surgical alterations are the main sources of T2-hypointense mimickers.• Multisequence interpretation, morphologic assessment, and precise anatomic localization are crucial to prevent overdiagnosis.• Gadolinium injection is beneficial for assessing endometriosis differential diagnosis only in specific conditions.
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Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | | | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Flavia Grangeon
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Pierre-Adrien Bolze
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques Et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France.
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Ayesha S, Zaidi SMF, Shahid R, Khan NA, Sohail Rangwala B. Exploring the link between long-term intrauterine contraceptive device usage and abdominal actinomycosis in a middle-aged female: A case report. SAGE Open Med Case Rep 2024; 12:2050313X231222222. [PMID: 38187812 PMCID: PMC10768593 DOI: 10.1177/2050313x231222222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Actinomycosis is a rare, chronic, and suppurative disease caused by Actinomyces species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of Actinomyces within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.
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Affiliation(s)
- Shabih Ayesha
- Department of Neurosurgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan
| | | | - Ruqaiya Shahid
- Department of Histopathology, Dow University Hospital, Karachi, Pakistan
| | - Naveed Ali Khan
- Department of Surgery, Dow University Hospital, Karachi, Pakistan
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Lesmana A, Wirdhani V, Perangin Angin LBR, Muzakky MI, Hayon SGV, Sholihah MM, Hanif MI. Sigmoid colon pseudotumor of actinomycosis: a rare case. J Surg Case Rep 2024; 2024:rjad697. [PMID: 38186751 PMCID: PMC10766591 DOI: 10.1093/jscr/rjad697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Actinomycosis is a chronic suppurative infection caused by gram-positive bacteria, Actinomyces, which commonly colonize the oral cavity, urogenital tract and gastrointestinal tract. It causes opportunistic infection where the mucosal barrier is compromised and is often misdiagnosed as malignancy. We report a case of a 58-year-old female with severe abdominal pain and a palpable tender mass in the left lower quadrant. Computed tomography scan with contrast showed thickening of the transverse, descending to sigmoid colon wall and intense contrast enhancement resembling colitis with mesenteritis. At laparotomy, we found an adherent mass involving sigmoid colon with adjacent small bowel and peritoneum. We decided to perform adhesiolysis and Hartmann procedure. The culture result was negative, whereas the biopsy of sigmoid colon revealed characteristic sulfur granules of actinomycosis colony. Intravenous antibiotic combination of ceftazidime and metronidazole was administered for 14 days followed by complete resolution of symptoms. Histopathological and bacteriological examinations are keys to diagnose actinomycosis. Patients require long-term antibiotic therapy, but surgery is often required because preoperative diagnosis is difficult. Main novel aspects? We presented the rare case of intra-abdominal actinomycosis in IndonesiaThe case was challenging to diagnose pre-operatively based on physical examination andExploratory laparotomy revealed pseudotumor mimicking advanced stage of colon neoplasm.
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Affiliation(s)
- Andy Lesmana
- Surgery Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Vika Wirdhani
- Internal Medicine Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | | | - Muhamad I Muzakky
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Stefi G V Hayon
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Mentari M Sholihah
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Muhammad I Hanif
- Emergency Department, Badau Primary Health Care, Kapuas Hulu, Indonesia
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McKeever C, Jayasankar B, Mathew Simon N, Abdul Aal Y, Papadopoulos A. Intra-Abdominal Actinomycosis: An Indolent Masquerader of Malignancy. Cureus 2023; 15:e50215. [PMID: 38192946 PMCID: PMC10772936 DOI: 10.7759/cureus.50215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
This report describes the case of a 54-year-old female who presented with the constitutional symptoms of lethargy, weight loss, and asthenia. She had been extensively investigated for possible gynaecological malignancy but with no definitive outcome achieved. The symptoms were persistent and, partly due to occurring during the coronavirus disease 2019 (COVID-19) pandemic, a decision was made to progress with surgical management. Following an oncology multidisciplinary meeting, a decision was made for a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intra-operatively, there was an incidental finding of an extensive tumour infiltrating the liver, colon, anterior abdominal wall and urinary bladder. A surgical resection with ileostomy was performed on suspicion of an underlying malignancy. Unexpectedly, the histopathological diagnosis revealed actinomycosis. Following this discovery, our entire management plan was altered, and the patient was treated with a prolonged course of antibiotics and recovered well.
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Affiliation(s)
- Catherine McKeever
- General Surgery, North West Anglia NHS Foundation Trust, Huntingdon, GBR
| | - Balaji Jayasankar
- General Surgery, North West Anglia NHS Foundation Trust, Huntingdon, GBR
| | | | - Yasser Abdul Aal
- Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, GBR
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Bohara S, Khadka M, Bhat PS, Syangtang P, Karki B, Shrestha B, Acharya SA, Khetan K, Rayamajhi J, Rawal SB. Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal. Clin Case Rep 2023; 11:e7996. [PMID: 37786458 PMCID: PMC10541570 DOI: 10.1002/ccr3.7996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Key Clinical Message Actinomycosis is a rare cause of appendicitis with an incidence of 0.3-1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Abstract Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36-year-old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination.
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Affiliation(s)
- Sujan Bohara
- Department of Cardiovascular SurgerySahid Gangalal National Heart CentreKathmanduNepal
| | - Manoj Khadka
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Pawan Singh Bhat
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
| | - Prajwal Syangtang
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Badal Karki
- Department of General SurgeryMadan Bhandari Hospital, and Trauma CenterUrlabariNepal
| | - Bhagawan Shrestha
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | | | - Khusbhu Khetan
- Department of Laboratory medicine and pathologyNepal MedicitiLalitpurNepal
| | - Jyoti Rayamajhi
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
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7
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Alqahtani AM, Alwadi FA, Almahdi M. Actinomycosis of the paranasal sinuses: case report and literature review. J Surg Case Rep 2023; 2023:rjad436. [PMID: 37583613 PMCID: PMC10425260 DOI: 10.1093/jscr/rjad436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023] Open
Abstract
Actinomycosis is a chronic granulomatous condition caused by filamentous gram-positive anaerobic bacteria that colonizes the mouth, gastrointestinal tract and urogenital tract. Infection occurs through the mucosal surfaces, often resulting from dental procedures or trauma, primarily affecting the maxillary sinus. We report a case of Actinomyces sinusitis affecting the right maxillary and right ethmoidal sinuses of a 41-year-old woman. The diagnosis was made through a combination of histopathological report and computed tomography scan. The patient underwent endoscopic sinus surgery followed by long-term antibiotics for 6 months and reported improvement of her symptoms.
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Affiliation(s)
- Abdullah M Alqahtani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad A Alwadi
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Almahdi
- Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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Freire L, Santos C, Duarte F, Tavares C, Silva CQ. A Rare Complication of Actinomyces Abdominal Infection: A Case Report. Cureus 2023; 15:e36524. [PMID: 37090375 PMCID: PMC10121248 DOI: 10.7759/cureus.36524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/25/2023] Open
Abstract
Intraabdominal infection by Actinomyces species, although a rare condition, usually occurs after a disruption of the mucosal barrier in a peritoneal organ. This infection is characterized by the development of an extended and persistent inflammatory and fibrotic reaction that can be mistaken for other pathogens or different etiologies, like tumors or inflammatory diseases. It can present as an abscess, a stricturing tissue with multiple adhesions, and/or a fistulization. Early diagnosis, targeted and prolonged antimicrobial therapy, and optimal drainage when indicated, are the key to success. The authors present a case where laparotomic hysterectomy was complicated by a superficial and an organ/space surgical site infection due to Actinomyces with a posterior developing of a colo-vaginal fistula that was treated surgically.
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Affiliation(s)
- Lígia Freire
- General Surgery, Hospital Pedro Hispano, Matosinhos, PRT
| | - Cláudia Santos
- General Surgery, Hospital Pedro Hispano, Matosinhos, PRT
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9
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Thapa K, Sarker M, Graman P. Thoracoabdominal actinomycosis associated with laparoscopic cholecystectomy and mimicking metastatic pulmonary malignancy. BMJ Case Rep 2022; 15:e250921. [PMID: 35906040 PMCID: PMC9344986 DOI: 10.1136/bcr-2022-250921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Actinomyces naeslundii is rarely isolated in cases of actinomycosis. We present a case of thoracoabdominal actinomycosis caused by inadvertent enterotomy and gallstone spillage during a laparoscopic cholecystectomy. The actinomycosis initially presented as recurrent episodes of pneumonia, shortness of breath and unintentional weight loss. Initial CT imaging demonstrated pleural thickening along the right lung base as well as ill-defined consolidation in the right lower lobe. Repeat CT imaging showed progression of the mass-like region of consolidation with extrapulmonary spread to involve the abdomen, retroperitoneum and retrohepatic areas. Treatment involved intravenous antibiotics with concurrent abscess drainage followed by oral antibiotics.
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Affiliation(s)
- Kriti Thapa
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Moumita Sarker
- Department of Infectious Diseases, Mary Washington Healthcare, Fredericksburg, Virginia, USA
| | - Paul Graman
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Feakins R, Torres J, Borralho-Nunes P, Burisch J, Cúrdia Gonçalves T, De Ridder L, Driessen A, Lobatón T, Menchén L, Mookhoek A, Noor N, Svrcek M, Villanacci V, Zidar N, Tripathi M. ECCO Topical Review on Clinicopathological Spectrum and Differential Diagnosis of Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:343-368. [PMID: 34346490 DOI: 10.1093/ecco-jcc/jjab141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics. METHODS European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search. RESULTS Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements. CONCLUSIONS Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.
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Affiliation(s)
- Roger Feakins
- Department of Cellular Pathology, Royal Free Hospital, London, and University College London, UK
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Paula Borralho-Nunes
- Department of Pathology, Hospital Cuf Descobertas, Lisboa and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Lissy De Ridder
- Department of Paediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands
| | - Ann Driessen
- Department of Pathology, University Hospital Antwerp, University Antwerp, Edegem, Belgium
| | - Triana Lobatón
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Luis Menchén
- Department of Digestive System Medicine, Hospital General Universitario-Insitituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Aart Mookhoek
- Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Magali Svrcek
- Department of Pathology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Vincenzo Villanacci
- Department of Histopathology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Tripathi
- Department of Histopathology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Frutuoso L, Pereira AM, Oliveira V, Gonçalves G, Nora M. Hepatic Actinomycosis Mimicking Malignancy After Pancreaticoduodenectomy: A Case Report. Cureus 2022; 14:e21234. [PMID: 35186530 PMCID: PMC8844254 DOI: 10.7759/cureus.21234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
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Ordaya EE, Arriola-Montenegro J, Arriola-Montenegro L, Anderson ML. Double Trouble: A Unique Case of Hypercalcemia Caused by Two Underlying Etiologies. Cureus 2022; 14:e21084. [PMID: 35155033 PMCID: PMC8825322 DOI: 10.7759/cureus.21084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Hypercalcemia has a variety of causes, with primary hyperparathyroidism and malignancies being the most frequently reported. We present the case of a patient presenting with chronic abdominal pain, constipation, and weight loss who was found to have hypercalcemia. The patient was initially diagnosed with colonic actinomycosis, but further investigations revealed an intra-abdominal diffuse large B-cell lymphoma (DLBCL). We suspect that the leading cause of hypercalcemia was the DLBCL, likely exacerbated by actinomycosis. Actinomycosis and DLBCL can have a similar presentation, so misdiagnosis or coexistence of both conditions should be suspected when a lack of response to one specific therapy is observed.
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13
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Wolff A, Rodloff AC, Vielkind P, Borgmann T, Stingu CS. Antimicrobial Susceptibility of Clinical Oral Isolates of Actinomyces spp. Microorganisms 2022; 10:microorganisms10010125. [PMID: 35056574 PMCID: PMC8779083 DOI: 10.3390/microorganisms10010125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/10/2022] Open
Abstract
Actinomyces species play an important role in the pathogenesis of oral diseases and infections. Susceptibility testing is not always routinely performed, and one may oversee a shift in resistance patterns. The aim of the study was to analyze the antimicrobial susceptibility of 100 well-identified clinical oral isolates of Actinomyces spp. against eight selected antimicrobial agents using the agar dilution (AD) and E-Test (ET) methods. We observed no to low resistance against penicillin, ampicillin-sulbactam, meropenem, clindamycin, linezolid and tigecycline (0-2% ET, 0% AD) but high levels of resistance to moxifloxacin (93% ET, 87% AD) and daptomycin (83% ET, 95% AD). The essential agreement of the two methods was very good for benzylpenicillin (EA 95%) and meropenem (EA 92%). The ET method was reliable for correctly categorizing susceptibility, in comparison with the reference method agar dilution, except for daptomycin (categorical agreement 87%). Penicillin is still the first-choice antibiotic for therapy of diseases caused by Actinomyces spp.
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14
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Khan N, Waheed S, Alkhateb R. Triple whammy: a rare case of epithelioid hemangioendothelioma with synchronous angiomyomatous hamartoma complicated by Actinomyces meyeri. Arch Clin Cases 2022; 8:56-61. [PMID: 34984227 PMCID: PMC8717002 DOI: 10.22551/2021.32.0803.10187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Epithelioid hemangioendothelioma is a rare vascular malignancy that originates from vascular endothelial or pre-endothelial cells and is composed of epithelioid or histiocytoid cells. This malignancy has an incidence of approximately one per one million individuals and can occur in various regions of the body including the lungs, liver, bones, and soft tissues. The behavior of this cancer can range from indolent to aggressive and diagnosis and treatment are often delayed due to variable presentations and lack of established treatment guidelines. Here we present the case of a 27-year-old Hispanic male that presented with right groin pain, abdominal pain, and a fifty-pound weight loss over one year. The patient had a complex hospital course during which he was found to have an angiomyomatous hamartoma of his right groin area, postsurgical right inguinal wound infection with Actinomyces meyeri, and epithelioid hemangioendothelioma distal to the right iliac bifurcation. The patient is currently pending further imaging studies to evaluate candidacy for surgical resection and following with oncology for chemotherapeutic options.
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Affiliation(s)
- Nariman Khan
- Department of Internal Medicine, University of Texas Health Science Center San Antonio, TX, USA
| | - Saadia Waheed
- Department of Internal Medicine, University of Texas Health Science Center San Antonio, TX, USA
| | - Rahaf Alkhateb
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center San Antonio, TX, USA
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15
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Iqbal A, Fujimura T, Shinjoh M, Furuichi M, Iimori T, Umeyama T, Ishida T, Morinaga S, Kamimaki I, Ohkusu K, Takahashi T. The first case report of pediatric acute appendicitis caused by "Candidatus Actinobaculum timonae". J Infect Chemother 2021; 28:451-454. [PMID: 34887179 DOI: 10.1016/j.jiac.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
A 14-year-old boy presented to the hospital with pain in the right lower abdomen. His condition was diagnosed as acute appendicitis. An emergency operation was performed, and histopathological examination revealed an actinomycete-related organism in the excised appendicitis specimen. On 16S rRNA gene sequence analysis, "Candidatus Actinobaculum timonae" was identified, which is the first known case in a pediatric patient.
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Affiliation(s)
- Asef Iqbal
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Takumi Fujimura
- Department of Pediatric Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan.
| | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Takashi Iimori
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Tomoshige Umeyama
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Tsuyoshi Ishida
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Shojiro Morinaga
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Isamu Kamimaki
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
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16
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Abdominal actinomycosis mimicking malignancy: A case report. IDCases 2021; 25:e01252. [PMID: 34430205 PMCID: PMC8374402 DOI: 10.1016/j.idcr.2021.e01252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Actinomycosis is the infection caused by Actinomyces bacilli; subtypes include cervicofacial, pulmonary, and abdominal/pelvic actinomycosis. Abdominal actinomycosis can mimic intra-abdominal malignancies by causing manifestations like chronic lower abdominal pain, weight loss, and palpable mass(es). Treatment usually requires three to six months of high-dose penicillin G or amoxicillin. This report discusses an 88-year-old female who presented with chronic abdominal pain, weight loss, and other nonspecific symptoms without palpable abdominal mass. However, computed tomography (C.T.) imaging revealed multiple intra-abdominal soft tissue masses in the greater omentum, anterior abdominal wall, and small bowel mesentery. On biopsy, filamentous bacilli suspicious of Actinomyces was identified. The patient received prolonged antimicrobial treatment, underwent multiple CT-guided aspirations of recurrent abscesses, and had surgical intervention for sigmoid stricture. On subsequent imaging, the patient showed significant amelioration of omental and anterior abdominal wall masses. This case highlights the importance of prompt recognition and subsequent management of Actinomyces as an etiology of malignancy-like symptoms.
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17
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Goh N, Bundele MM, Wee Liang En I, Siew Ching Hsia C. Middle-aged Lady With Extensive Omental Caking, Peritoneal Nodules, and Pelvic Masses. Clin Infect Dis 2021; 73:747-749. [PMID: 34398960 DOI: 10.1093/cid/ciaa1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicholette Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Ian Wee Liang En
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
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18
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Actinomycosis: Case report of an unusual cause of diaphragmatic herniation. Int J Surg Case Rep 2021; 85:106227. [PMID: 34343798 PMCID: PMC8350000 DOI: 10.1016/j.ijscr.2021.106227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction We present a case of actinomycosis which resulted in a symptomatic diaphragmatic hernia requiring operative repair, an unusual complication not found in the literature. Actinomycosis is a chronic, slowly progressive infection caused by the bacterial genus Actinomyces which characteristically causes necrosis and abscess formation in a myriad of organ systems. Case presentation A 5 year old male presented with nonspecific symptoms which were, after a short delay, identified as actinomycosis and treated with appropriate antibiosis. His infection was complicated by development of a diaphragmatic hernia, which subsequently became symptomatic and required surgical repair. Clinical discussion While this diaphragmatic hernia is an unusual complication of actinomycosis not previously found in the literature, the patient's delayed diagnosis of the infection is typical. Surgical intervention was warranted for symptoms of the sequelae of the disease, not control of the disease itself. Conclusion Laparoscopic repair of the multiple diaphragmatic defects was successful with a intraperitoneal on-lay biologic mesh, with resolution of symptoms. It is possible the need for surgical intervention in future cases of actinomycosis could be avoided with higher index of suspicion leading to earlier diagnosis. Actinomycosis is an indolent, difficult to diagnose infection. Actinomycosis causes a wide variety of pathology. Intraperitoneal onlay mesh for repair of diaphragmatic hernia.
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19
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Sibomana I, Ishimwe M, Maniriho B, Nyampinga C, Ruhangaza D, Gahemba I. Actinomycetoma of the colon presenting as abdominal wall abscess. Case report and review of the literature. Int J Surg Case Rep 2021; 80:105679. [PMID: 33636407 PMCID: PMC7918272 DOI: 10.1016/j.ijscr.2021.105679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
Abdominal actinomycetoma is a rare case and difficult to diagnose and treat. Due to different clinical presentation, diagnosis is often retrospective based on tissue biopsy or microbiology. Surgery and antibiotherapy are curative.
Introduction and importance Abdominal actinomycetoma is a rare and often a missed diagnosis by most of clinicians due to its rarity and different clinical presentations. It is caused by Actinomyces speces which are gram positive bacilli and normal commensal inhabitants of the human bronchial and gastrointestinal tracts. A.Israelli is responsible for disease in humans once the mucosal barrier is broken. Case presentation This case report presents an adult female patient who consulted for a localized abdominal wall mass of 3 weeks duration and the clinical exam was in favor of an abdominal wall abscess, but later found to be an actinomycotoma of the colon invading the abdominal wall and forming an abdominal wall abscess. Transverse colectomy and drainage of abscess was done and she improved well. Clinical discussion Actinomycosis is common in the tropical and subtropical area. However, this is the first case reported in Rwanda and prompt surgical treatment and antibiotherapy have led to a good clinical outcome. Conclusion Abdominal actinomycetoma should be considered as a differential diagnosis of any abdominal wall mass for patients with known risk factors and surgery and antibiotics are the only curative treatment.
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Affiliation(s)
- Isaie Sibomana
- Department of Surgery, Kibuye Referral Hospital, Rwanda.
| | | | | | - Carine Nyampinga
- Department of Pathology, Butaro District Hospital/Cancer Center of Excellence, Rwanda
| | - Deogratias Ruhangaza
- Department of Pathology, Butaro District Hospital/Cancer Center of Excellence, Rwanda
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20
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Actinomyces in explanted transvaginal mesh: commensal or pathogen? Int Urogynecol J 2021; 32:3053-3059. [PMID: 33416964 DOI: 10.1007/s00192-020-04610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a paucity of information in the literature regarding the clinical impact and treatment of histologically positive actinomycosis explanted vaginal mesh. We aimed to report the prevalence and independent predicators of Actinomyces presence in explanted meshes on histology and to compare the clinical course in those with and without Actinomyces. Our hypothesis is that Actinomyces may act as a commensal rather than a pathogen when identified in extracted transvaginal meshes. METHODS A single-center retrospective review of explanted vaginal mesh removed between 2013 and 2018 was undertaken and compared Actinomyces-positive and -negative cohorts on histology. Uni- and multivariate logistic regression analysis evaluated possible risk factors for positive Actinomyces including patient demographics, smoking, diabetes, hormone replacement therapy (vaginal/systemic), hysterectomy in primary surgery, rate and indication for prior mesh removal. The rate of symptom resolution or need for subsequent mesh excisions is compared between the two cohorts. RESULTS Actinomycosis was identified in 11% (31/278) of explanted mesh. After multivariant analysis, only voiding dysfunction as an indication for mesh removal was statistically significantly associated with Actinomyces-negative histology (14 vs 0%, p < 0.001). At median review of 17 months, symptom resolution (87% vs 83% p = 0.68) and need for subsequent mesh removal (13% vs 19%, p = 0.37) following index mesh excision were similar between the groups. CONCLUSION Actinomyces in explanted transvaginal mesh frequently acts as a commensal in those who are infection free. In this cohort, individualized care including conservative surveillance without antibiotics or full explantation is reasonable.
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21
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Johnson L, Shapiro M, Stricker RB, Vendrow J, Haddock J, Needell D. Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not? Healthcare (Basel) 2020; 8:healthcare8040383. [PMID: 33022914 PMCID: PMC7712932 DOI: 10.3390/healthcare8040383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023] Open
Abstract
There is considerable uncertainty regarding treatment of Lyme disease patients who do not respond fully to initial short-term antibiotic therapy. Choosing the best treatment approach and duration remains challenging because treatment response among these patients varies: some patients improve with treatment while others do not. A previous study examined treatment response variation in a sample of over 3500 patients enrolled in the MyLymeData patient registry developed by LymeDisease.org (San Ramon, CA, USA). That study used a validated Global Rating of Change (GROC) scale to identify three treatment response subgroups among Lyme disease patients who remained ill: nonresponders, low responders, and high responders. The present study first characterizes the health status, symptom severity, and percentage of treatment response across these three patient subgroups together with a fourth subgroup, patients who identify as well. We then employed machine learning techniques across these subgroups to determine features most closely associated with improved patient outcomes, and we used traditional statistical techniques to examine how these features relate to treatment response of the four groups. High treatment response was most closely associated with (1) the use of antibiotics or a combination of antibiotics and alternative treatments, (2) longer duration of treatment, and (3) oversight by a clinician whose practice focused on the treatment of tick-borne diseases.
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Affiliation(s)
| | - Mira Shapiro
- Analytic Designers LLC, Bethesda, MD 20817, USA;
| | - Raphael B. Stricker
- Union Square Medical Associates, San Francisco, CA 94108, USA
- Correspondence: ; Tel.: +1-415-399-1035; Fax: +1-415-399-1057
| | - Joshua Vendrow
- Department of Mathematics, University of California, Los Angeles, CA 90095, USA; (J.V.); (J.H.); (D.N.)
| | - Jamie Haddock
- Department of Mathematics, University of California, Los Angeles, CA 90095, USA; (J.V.); (J.H.); (D.N.)
| | - Deanna Needell
- Department of Mathematics, University of California, Los Angeles, CA 90095, USA; (J.V.); (J.H.); (D.N.)
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22
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Jones P, Ho C, Juliebø SØ, Hawary A. Pelvic actinomycosis: a forgotten cause of pelvic pain. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 33135910 DOI: 10.12968/hmed.2020.0190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6-12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Great Western Hospital, Swindon, UK
| | - Cherrie Ho
- Department of Urology, Great Western Hospital, Swindon, UK
| | | | - Amr Hawary
- Department of Urology, Great Western Hospital, Swindon, UK
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23
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Agrawal A, Huang KG. A Uterine Actinomycosis with Extensive Pelvic Involvement. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ajay Agrawal
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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24
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Manterola C, Grande L, Riffo‐Campos ÁL, Salgado C, Otzen T. Clinical aspects of abdominal actinomycosis: a systematic review. ANZ J Surg 2020; 90:1465-1468. [DOI: 10.1111/ans.16141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Manterola
- Department of SurgeryUniversidad de La Frontera Temuco Chile
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
| | - Luis Grande
- Department of SurgeryHospital del Mar/Institut Hospital del Mar d'Investigacions Mèdiques Barcelona Spain
- Department of SurgeryUniversitat Autònoma de Barcelona Barcelona Spain
| | | | - Carla Salgado
- Department of MedicineUniversidad del Azuay Cuenca Ecuador
| | - Tamara Otzen
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
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25
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Elmohr MM, Elsayes KM, Pickhardt PJ. Non-neoplastic conditions mimicking peritoneal carcinomatosis at CT imaging. Br J Radiol 2020; 93:20200401. [PMID: 32516560 DOI: 10.1259/bjr.20200401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The general appearance of peritoneal carcinomatosis at abdominal CT and other cross-sectional imaging modalities consists of varying amounts of peritoneal-based soft tissue implants (mass-forming or infiltrative), peritoneal fluid, and occasionally calcification. However, a wide variety of common and uncommon neoplastic and non-neoplastic conditions can closely mimic peritoneal carcinomatosis at imaging. Neoplastic mimics of peritoneal carcinomatosis include primary peritoneal and sub peritoneal tumors, as well as peritoneal lymphomatosis and sarcomatosis.Broad categories of non-neoplastic mimics of peritoneal carcinomatosis include tumor-like conditions, systemic processes, atypical infections, and fat-based conditions. For many entities, suggestive or specific patient information and/or CT imaging findings exist that may allow the radiologist to narrow the differential diagnosis. In this article, we review the salient clinical and cross-sectional imaging features of non-neoplastic mimics of peritoneal carcinomatosis and malignancy, with emphasis on the CT findings and the additional clues that may suggest the correct benign diagnosis.
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Affiliation(s)
- Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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26
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Sung YN, Kim J. Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease. J Pathol Transl Med 2020; 55:349-354. [PMID: 32580538 PMCID: PMC8476320 DOI: 10.4132/jptm.2020.05.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
Appendiceal actinomycosis is very rare and its diagnosis is often difficult even in surgically resected specimens. Here we report two cases of appendiceal actinomycosis confirmed by pathologic examination of surgically resected specimens. Characteristic histologic features included transmural chronic inflammation with Crohn-like lymphoid aggregates and polypoid mucosal protrusion into cecal lumen through fibrous expansion of the submucosa. Chronic active inflammation involved the mucosa of the appendix and cecum around the appendiceal orifice. Crohn’s disease with predominant cecal involvement and inflammatory pseudotumor were considered as differential diagnoses. Careful examination revealed a few actinomycotic colonies in the mucosa, confirming the diagnosis. A high index of suspicion with awareness of the characteristic histologic features might prompt careful inspection for the actinomycotic colonies, leading to the appropriate diagnosis of this rare disease.
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Affiliation(s)
- You-Na Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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27
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Han Y, Cao Y, Zhang Y, Niu L, Wang S, Sang C. A Case Report of Pelvic Actinomycosis and a Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922601. [PMID: 32532952 PMCID: PMC7476745 DOI: 10.12659/ajcr.922601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to report the clinical diagnosis and treatment of a case of pelvic actinomycosis in our hospital and provide a review of recent literature. CASE REPORT The patient was a 54-year-old woman who was admitted to our hospital due to "bilateral lower abdominal tenderness accompanied with anorexia and vomiting for 3 months". After admission, a variety of imaging examinations found pelvic space-occupying lesions, which were considered as malignant. She underwent surgery and pelvic actinomycosis was diagnosed by postoperative pathology. Postoperatively, she was treated with a high-dose sufficient course of penicillin (20 million U, iv gtt) for 14 days and she is currently under close follow-up for 1 year, with no recurrent symptoms. CONCLUSIONS Pelvic actinomycosis is rare and often forms mass invasion into the tissue structure around the pelvic cavity, which is easily misdiagnosed as ovarian malignant tumor. The criterion standard for diagnosing an infection is culture, with histopathology aiding the diagnosis.
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Affiliation(s)
- Ying Han
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yang Cao
- Department of Obstetrics and Gynecology, Beijing Huai-Rou Hospital, Beijing, China (mainland)
| | - YanJun Zhang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Lin Niu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (mainland)
| | - ShuZhen Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (mainland)
| | - CuiQin Sang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (mainland)
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28
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Asiri BI, Alshehri AA, Alqahtani AS, Albishi AM, Assiri YI, Asmiri EA. Caecum actinomycosis with acute abdomen: A case report. J Taibah Univ Med Sci 2020; 15:148-152. [PMID: 32368212 PMCID: PMC7184210 DOI: 10.1016/j.jtumed.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
Abdominal actinomycosis, one of the causes of ileocaecal disorders, is usually considered when other more common clinical conditions have been excluded. Actinomycosis is a rare infectious bacterial disorder caused by the Actinomyces species. We present the case of a 38-year male Saudi soldier who presented with pain in the right iliac fossa since 4 days prior to presentation. This stabbing pain started gradually. Based on clinical examination and abdominal ultrasound findings, an appendectomy was performed. Histological examination revealed appendicular actinomycosis with lymphoid hyperplasia, serosa congestion, and filamentous bacteria in the appendicular lumen. The patient was treated with amoxicillin. During follow-up, contrast-enhanced abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 cm thickened caecal wall. Thereafter, the patient underwent laparoscope-assisted ileocaecal resection with ileocolic anastomosis. The histological report revealed calcified food material in the diverticulum, with chronic inflammation without actinomycosis, which may have been eradicated by the previous antibiotic treatment.
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Affiliation(s)
- Bader I. Asiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
- Corresponding address: Internal Medicine, Armed Forces Hospital Southern Region Armed Forces Hospital Southern Region, KSA.
| | - Ali A. Alshehri
- Infectious Diseases, Armed Forces Hospital Southern Region, KSA
| | | | - Abdullah M. Albishi
- Internal Medicine, Gastrology and Endoscopy, Armed Forces Hospital Southern Region, KSA
| | - Yahia I. Assiri
- Radiology, College of Medicine in King Khalid University, KSA
| | - Esam A. Asmiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
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29
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Cho IS, Bae SU, Jung HR, Park KS, Jeong WK, Baek SK. Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach. Ann Coloproctol 2020; 37:125-128. [PMID: 32178493 PMCID: PMC8134922 DOI: 10.3393/ac.2019.08.10.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/10/2019] [Indexed: 12/30/2022] Open
Abstract
Actinomycosis is an inflammatory disease with various clinical presentations including inflammation and formation of masses. There are several reports suggesting the infiltrative mass-like nature of actinomycosis that is misunderstood as a tumor. A 39-year-old male clinically presented with a fungating mass-like lesion during colonoscopy for healthcare screening. Biopsy was performed for the lesion, and chronic inflammation was diagnosed. Abdominal computed tomography (CT) suggested severe edematous changes in the appendix with an appendicolith, suspected chronic inflammation, and wall thickening of the cecal base, but malignancy could not be definitively ruled out. The patient underwent a laparoscopic single-port cecectomy based on the possibility of cecal cancer. The final biopsy was diagnosed as actinomycosis, and the patient was prescribed antibiotics and showed no recurrence in the follow-up CT scan. We present this rare case of mass-like appendiceal actinomycosis treated with the single-port laparoscopic method.
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Affiliation(s)
- In Soo Cho
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Ra Jung
- Department of Pathology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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30
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Gajdács M, Urbán E, Terhes G. Microbiological and Clinical Aspects of Cervicofacial Actinomyces Infections: An Overview. Dent J (Basel) 2019; 7:dj7030085. [PMID: 31480587 PMCID: PMC6784480 DOI: 10.3390/dj7030085] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
Similarly to other non-spore-forming Gram-positive anaerobes, members of the Actinomyces genus are important saprophytic constituents of the normal microbiota of humans. Actinomyces infections are considered to be rare, with cervicofacial infections (also known as ‘lumpy jaw syndrome’) being the most prevalent type in the clinical practice. Actinomycoses are characterized by a slowly progressing (indolent) infection, with non-specific symptoms, and additionally, the clinical presentation of the signs/symptoms can mimic other pathologies, such as solid tumors, active Mycobacterium tuberculosis infections, nocardiosis, fungal infections, infarctions, and so on. The clinical diagnosis of actinomycosis may be difficult due to its non-specific symptoms and the fastidious, slow-growing nature of the pathogens, requiring an anaerobic atmosphere for primary isolation. Based on 111 references, the aim of this review is to summarize current advances regarding the clinical features, diagnostics, and therapy of cervicofacial Actinomyces infections and act as a paper for dentistry specialists, other physicians, and clinical microbiologists.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Eötvös utca 6., Hungary.
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Semmelweis utca 6., Hungary.
| | - Edit Urbán
- Department of Public Health, Faculty of Medicine, University of Szeged, 6720 Szeged, Dóm tér 10., Hungary
| | - Gabriella Terhes
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Semmelweis utca 6., Hungary
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31
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Horvath BA, Maryamchik E, Miller GC, Brown IS, Setia N, Mattia AR, Lamps L, Lauwers GY, Rosenberg E, Misdraji J. Actinomyces in Crohn's-like appendicitis. Histopathology 2019; 75:486-495. [PMID: 31155731 DOI: 10.1111/his.13929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 12/30/2022]
Abstract
AIMS Appendicitis with a Crohn's-like histological appearance generally raises concern for Crohn's disease, Yersinia infection, and interval appendectomy. Actinomyces infection is a recognised cause of chronic appendicitis that can histologically mimic Crohn's disease. METHODS AND RESULTS We report on 20 cases of appendicitis with Crohn's-like histological features that were due to Actinomyces. Most patients presented with acute or chronic abdominal pain. Imaging studies suggested a mass in five cases. Two patients had interval appendectomy. Histological features showed Crohn's-like appendicitis in 16 cases, with moderate to marked fibrosis and granulomas in seven cases. The other four cases had less consistent histological findings. None of the patients developed Crohn's disease during the follow-up interval (median, 37 months). CONCLUSIONS Actinomyces can be associated with Crohn's-like appendicitis with marked fibrosis, transmural inflammation, lymphoid hyperplasia, and granulomas.
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Affiliation(s)
- Bela A Horvath
- Eastern Connecticut Pathology Consultants, Manchester, CT, USA
| | - Elena Maryamchik
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory C Miller
- Envoi Specialist Pathologists, Kelvin Grove, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian S Brown
- Envoi Specialist Pathologists, Kelvin Grove, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Namrata Setia
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Anthony R Mattia
- Department of Pathology, Newton-Wellesley Hospital, Newton, MA, USA
| | - Laura Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Eric Rosenberg
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Infectious Diseases Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Roh YH, Park KJ, Byun KD, Roh MS, Choi HJ. Abdominal actinomycosis misconceived as intestinal lymphoma: Report of a case. Int J Surg Case Rep 2019; 60:171-174. [PMID: 31229771 PMCID: PMC6597478 DOI: 10.1016/j.ijscr.2019.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Abdominal actinomycosis is a rare clinical entity and it is difficult to make the correct preoperative diagnosis because of its nonspecific clinical symptoms and varied radiological findings. The diagnosis is usually made after the patient undergoes an operation and tissue is available for pathological evaluation. When the diagnosis is made, the patient should be treated with the appropriate long-term antibiotics. PRESENTATION OF CASE A 69-year-old male patient was transferred to our hospital complaining of a palpable mass, painful abdominal discomfort, weight loss, and night sweating. After colonoscopy and radiologic studies, our presumptive diagnosis was intestinal lymphoma combined with ileocecal intussusception. He was found to have abdominal actinomycosis after surgery and successfully treated with ampicillin for six months. DISCUSSION Pre-operative radiological imaging in abdominal actinomycosis is unlikely to allow a definitive diagnosis, but CT scanning is the single most useful imaging modality. Although we performed preoperative radiological studies, including CT, none led to a diagnosis of abdominal actinomycosis, we mistakenly considered the case as intestinal lymphoma combined with ileocecal intussusception. CONCLUSION Physicians should include abdominal actinomycosis in the differential diagnosis when an abdominal mass presents an irregular, infiltrative growth pattern, even though ileocecal intussusception is an extremely rare presentation in abdominal actinomycosis.
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Affiliation(s)
- Young-Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Ki-Jae Park
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea.
| | - Kyung-Do Byun
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Mee-Sook Roh
- Department of Pathology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hong-Jo Choi
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
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Bronswijk M, Victoor J, Cuyle PJ. Deep ulcerative esophagitis: A rare presentation of gastrointestinal actinomycosis. Dig Liver Dis 2019; 51:907. [PMID: 30824406 DOI: 10.1016/j.dld.2019.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium; Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium.
| | - Jasper Victoor
- Department of Pathology, Imelda General Hospital, Bonheiden, Belgium
| | - Pieter-Jan Cuyle
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium; Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
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34
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Link PJ, Stiles ZE, Kaminsky J, Dill D, Mazumder S, Deneve JL. Ruptured Appendicitis and a Palpable Mass: Delayed Presentation of Appendiceal Actinomycosis. Am Surg 2019. [DOI: 10.1177/000313481908500408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Phillip J. Link
- College of Medicine University of Tennessee Health Science Center Memphis, Tennessee
| | - Zachary E. Stiles
- Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee
| | - Joseph Kaminsky
- Department of Pathology and Laboratory Medicine University of Tennessee Health Science Center Memphis, Tennessee
| | - Drew Dill
- Medical Oncology Group Baptist Medical Group Memphis, Tennessee
| | - Shirin Mazumder
- Infectious Diseases University of Tennessee Medical Group Memphis, Tennessee
| | - Jeremiah L. Deneve
- Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee
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35
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Esophageal Stricture Caused by Actinomyces in a Patient with No Apparent Predisposing Factors. Case Rep Gastrointest Med 2019; 2019:7182976. [PMID: 30719360 PMCID: PMC6334373 DOI: 10.1155/2019/7182976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022] Open
Abstract
Actinomyces species are Gram positive anaerobic or microaerophilic bacteria that are part of the human flora in the oropharyngeal, gastrointestinal, and genitourinary tract. In the presence of a mucosal injury, they can become pathogenic and infect the underlying tissue without respect for tissue planes, leading to abscesses, fistulas, and sinus tracts. Through contiguous and hematogenous spread, virtually any organ can become infected. The presentation can be myriad and often mimics tumors, tuberculosis, or other more common infections and inflammatory conditions. While the cervicofacial region is the most common site of infection, involvement of the esophagus is unusual. Esophageal actinomycosis mostly occurs in patients with compromised immunity or prior esophageal injuries. Occurrence in immunocompetent individuals without risk factors is exceedingly rare. We report a case of esophageal actinomycosis complicated by an esophageal stricture in a patient with no apparent predisposing conditions.
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Agnihotri M, Kothari K, Naik L. Primary actinomycosis of anterior abdominal wall: A rare occurrence, diagnosed on fine needle aspiration cytology. INDIAN J PATHOL MICR 2019; 62:629-630. [DOI: 10.4103/ijpm.ijpm_193_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Renal Actinomycosis, A Rare Diagnosis Which Can Clinically Mimic a Malignancy, Case Report and Review of the Literature. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.10.5812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Renal Actinomycosis, A Rare Diagnosis Which Can Clinically Mimic a Malignancy, Case Report and Review of the Literature. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.13049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Chinnakkulam Kandhasamy S, Rajendar B, Sahoo AK, Nachiappa Ganesh R, Goneppanavar M, Nelamangala Ramakrishnaiah VP. Rare Abdominopelvic Actinomycosis Causing an Intestinal Band Obstruction and Mimicking an Ovarian Malignancy. Cureus 2018; 10:e2721. [PMID: 30079287 PMCID: PMC6067810 DOI: 10.7759/cureus.2721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Actinomyces israelii, a commensal of the bronchial and gastrointestinal tracts, is responsible for the majority of actinomycostic infections in humans. Actinomycosis has widely varying clinical presentations ranging from asymptomatic states to infiltrative mass lesions that mimic malignant abdominopelvic disease. Described as one of the most misdiagnosed diseases, actinomycosis poses challenges to accurate preoperative diagnosis. A 67-year-old woman with no significant medical history presented with features of acute intestinal obstruction. Computed tomography revealed a terminal ileal stricture causing intestinal obstruction and a right ovarian mass lesion. On laparotomy, a granular mass (2×2 cm) at the base of the mesentery and a right ovarian hard nodular growth (3×3 cm) were found that were connected by a dense fibrotic band, causing ileal obstruction with a transitional zone that was 10 cm proximal to the ileocecal junction. The mesenteric granular mass was excised together with the dense fibrotic band, and a right salpingo-oophorectomy was also undertaken. On postoperative histopathological examination, band formations by dense inflammatory tissue with neutrophilic infiltration were observed; moreover, there were sulfur granules that showed a positive reaction on Periodic Acid Schiff staining. The resected ovarian parenchyma showed infiltration by bacterial colonies with Splendore-Hoeppli phenomenon and evoked dense neutrophilic infiltration. The postoperative period was uneventful, and the patient was placed on penicillin therapy for a year. Abdominopelvic actinomycosis should constitute part of the differential diagnosis when evaluating mass lesions, especially in elderly women with a history of intrauterine device (IUD) use.
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Affiliation(s)
| | - Byshetty Rajendar
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Ashok Kumar Sahoo
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Mangala Goneppanavar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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Paulo CO, Jordão S, Correia-Pinto J, Ferreira F, Neves I. Actinomycosis, a lurking threat: a report of 11 cases and literature review. Rev Soc Bras Med Trop 2018. [PMID: 29513846 DOI: 10.1590/0037-8682-0215-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.
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Affiliation(s)
- Catarina Oliveira Paulo
- Infectious Diseases Unit, Medical Department, Hospital Pedro Hispano - Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Sofia Jordão
- Infectious Diseases Unit, Medical Department, Hospital Pedro Hispano - Matosinhos Local Health Unit, Matosinhos, Portugal
| | - João Correia-Pinto
- Department of Anatomical Pathology, Hospital Pedro Hispano - Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Fernando Ferreira
- Department of General Surgery, Hospital Pedro Hispano - Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Isabel Neves
- Infectious Diseases Unit, Medical Department, Hospital Pedro Hispano - Matosinhos Local Health Unit, Matosinhos, Portugal
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42
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Tsujimura N, Takemoto H, Nakahara Y, Wakasugi M, Matsumoto T, Nishioka K, Takachi K, Oshima S, Yoshida K. Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report. Int J Surg Case Rep 2018; 45:101-103. [PMID: 29604528 PMCID: PMC6000908 DOI: 10.1016/j.ijscr.2018.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/15/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022] Open
Abstract
Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Actinomycosis is one of the differential diagnoses of an abdominal mass. The first choice of treatment for actinomycosis is surgical resection.
Introduction Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively. Presentation of the case A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis. Discussion Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered. Conclusions We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses.
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Affiliation(s)
- Naoto Tsujimura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | | | | | | | - Kou Takachi
- Department of Surgery, Kinki Central Hospital, Hyogo, Japan
| | - Satoshi Oshima
- Department of Surgery, Kinki Central Hospital, Hyogo, Japan
| | - Kyotaro Yoshida
- Department of Pathology, Kinki Central Hospital, Hyogo, Japan
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43
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Abrego MO, De Cicco FL, Montenegro NB, Boretto JG, De Carli P, Gallucci GL. Refractory actinomycosis of the humerus. SAGE Open Med Case Rep 2018; 6:2050313X17752852. [PMID: 29348917 PMCID: PMC5768246 DOI: 10.1177/2050313x17752852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Abstract
Actinomycosis is a chronic, opportunistic infection caused by Actinomyces species, such as Actinomyces bacillus. Actinomycosis in long bones is very rare. To the best of our knowledge, isolated primary actinomycosis of the humerus is rarely reported in literature. We present a rare case of a refractory primary actinomycosis of the humerus. A 66-year-old man with no history of concomitant conditions was admitted to our hospital with a history of a tumour on the distal third of the left arm as a result of a closed trauma without fracture 20 years before. Pathological anatomy samples showed the presence of Actinomyces. Cultures were subjected to a prolonged incubation of 21 days under aerobic and anaerobic conditions and were always negative. He underwent several surgical procedures and received long-term antibiotic therapy with poor outcome. Primary actinomycosis in long bones is uncommon. Diagnosis may be challenging: considering the small number of case studies reported in the literature, symptoms are not specific, and the organism is difficult to isolate. Antibiotic treatment may not be sufficient to improve the clinical condition, and surgical alternatives should be considered.
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Affiliation(s)
| | | | | | | | - Pablo De Carli
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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44
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Belmar Vega L, Rodrigo Calabria E, Gutiérrez Fernández G, Casanova Rituerto D, González Sánchez FJ, Armiñanzas Castillo C, Roiz Mesones MP, Arias Rodriguez M. Infección por Actinomyces viscosus en trasplantado de riñón-páncreas. Nefrologia 2017; 37:431-432. [DOI: 10.1016/j.nefro.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/13/2016] [Accepted: 01/10/2017] [Indexed: 11/25/2022] Open
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45
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Nahum A, Filice G, Malhotra A. A Complicated Thread: Abdominal Actinomycosis in a Young Woman with Crohn Disease. Case Rep Gastroenterol 2017; 11:377-381. [PMID: 28690491 PMCID: PMC5498965 DOI: 10.1159/000475917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/18/2017] [Indexed: 12/31/2022] Open
Abstract
Crohn disease is a chronic inflammatory condition that primarily affects the gastrointestinal tract. Typical manifestations include fever, weight loss, fatigue, and abdominal pain, and abdominal abscesses and fistulae are frequent complications. Abdominal actinomycosis is a subacute or indolent disease associated with Actinomyces spp. Symptoms can be very similar to those of Crohn disease, and fistulae are also common. Since ulcerations in the intestinal tract are thought to be caused by Actinomyces escaping from the gut lumen and establishing intra-abdominal infection, it seems likely that abdominal actinomycosis may occur in patients with inflammatory bowel disease. We report a case of abdominal actinomycosis in a woman with active Crohn disease.
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Affiliation(s)
- Ari Nahum
- Minneapolis Veterans Hospital, Minneapolis, Minnesota, USA
| | - Gregory Filice
- Minneapolis Veterans Hospital, Minneapolis, Minnesota, USA
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46
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Gómez-Torres GA, Ortega-Gárcia OS, Gutierrez-López EG, Carballido-Murguía CA, Flores-Rios JA, López-Lizarraga CR, Bautista López CA, Ploneda-Valencia CF. A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review. Int J Surg Case Rep 2017; 36:46-49. [PMID: 28531869 PMCID: PMC5440354 DOI: 10.1016/j.ijscr.2017.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 12/27/2022] Open
Abstract
Actinomycosis represents only the 0.02% of causes of acute apendicitis. We present the first case of appendiceal actinomycosis reported in México. As to our knowledge, this is the first case in the literature with appendiceal actinomycosis without been perforated.
Introduction Acute appendicitis is the most common indication for an emergency abdominal surgery in the world, with a lifetime incidence of around 10%. Actinomycetes are the etiology of appendicitis in only 0.02%–0.06%, having as the final pathology report a chronic inflammatory response; less than 10% of the cases are diagnosed before surgery. Here, we present the case of a subacute appendicitis secondary to actinomycosis. Case report A 39-year-old male presented with a twelve-day evolution of intermittent abdominal pain in the right lower quadrant, treated at the beginning with ciprofloxacin and urinary analgesic. The day of the admission he referred intense abdominal pain with nausea. An open appendectomy was preformed, finding a tumor-like edematous appendix with a diameter of approximately 2.5 cm. Discussion Actinomyces are part of the typical flora of the oral cavity, gastrointestinal tract and vagina. The predominant form of human disease is A. Israelii, it requires an injury to the normal mucosa to penetrate and cause disease. Abdominal actinomycosis involves the appendix and caecum in 66% of the presentations, of these, perforated appendicitis is the stimulus in 75% of the cases. A combination of antibiotic therapy and operative treatment resolves actinomycosis in 90% of cases. Conclusion Abdominal actinomycosis is an uncommon disease been the common presentation a perforated appendicitis, here we present a less common presentation of it with a non-perforated appendix.
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Affiliation(s)
- G A Gómez-Torres
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México.
| | - O S Ortega-Gárcia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - E G Gutierrez-López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | | | - J A Flores-Rios
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C R López-Lizarraga
- Division of Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C A Bautista López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
| | - C F Ploneda-Valencia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", México
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47
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Lopes VN, Dantas MJ, Andrade P, Pinto-de-Sousa J. Secondary peritonitis by Actinomyces odontolyticus. Porto Biomed J 2017; 2:174-175. [PMID: 32258616 DOI: 10.1016/j.pbj.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022] Open
Abstract
Abdominal actinomycosis is a rare infection and the non-recognition of this particular microorganism may led to a prolonged septic process and recurrent disease. We hereby present a case report of 53 years-old woman with a secondary peritonitis due to this microorganism and our option to perform a long course of penicillin derived antibiotics, after suture of a perforated gastric ulcer caused by a foreign body.
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Affiliation(s)
- Vítor Neves Lopes
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Maria Jesus Dantas
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Paulo Andrade
- Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Infectious Diseases, Centro Hospitalar São João, Porto, Portugal
| | - João Pinto-de-Sousa
- Department of Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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48
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Yeo SJ, Cho CM, Jung MK, Kim KJ, Kim MH, Cho SH, Kim GC, Seo AN. [Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:191-195. [PMID: 28329923 DOI: 10.4166/kjg.2017.69.3.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.
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Affiliation(s)
- Seong Jae Yeo
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Kyu Jung
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ki Ju Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Myung Hi Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
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ŞABABOĞLU E, ŞAHAN YAPICIER Ö, ÇINAR H, TÜRÜTOĞLU H. BİR KEDİDE ACTINOMYCES NAESLUNDII OLGUSU. MEHMET AKIF ERSOY ÜNIVERSITESI VETERINER FAKÜLTESI DERGISI 2016. [DOI: 10.24880/maeuvfd.287348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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