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Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
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Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Amare A, Bekele M, Toma A, Ketema W. Laryngeal Actinomycosis -A Case of 36 Year Old Female at Hawassa University Comprehensive Specialized Hospital in Hawassa, Sidama, Ethiopia, Ethiopian Patient. Int Med Case Rep J 2022; 15:213-218. [PMID: 35495368 PMCID: PMC9048958 DOI: 10.2147/imcrj.s362541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abebaw Amare
- Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia
| | - Muluken Bekele
- Department of ENT, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia
| | - Alemayehu Toma
- Department of Pharmacology, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia
- Correspondence: Worku Ketema, Email
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Lin K, Lin S, Lin AN, Lin T, Htun ZM, Reddy M. A Rare Thermophilic Bug in Complicated Diverticular Abscess. Case Rep Gastroenterol 2017; 11:569-575. [PMID: 29118685 PMCID: PMC5662985 DOI: 10.1159/000480072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/01/2017] [Indexed: 12/17/2022] Open
Abstract
Actinomycosis is a form of painful abscess in the gastrointestinal tract or in deep tissue caused by actinomyces species. They are one of the commensal bacteria in the oral cavity and gastrointestinal tract of humans but can opportunistically cause infection in immunosuppressive hosts through invasion of breached mucosa or necrotic tissue while mimicking malignancy, gastrointestinal tuberculosis, and inflammatory bowel disease. Actinomyces israelii is, by far, the major and most common human pathogen throughout literatures. By virtue of rarity and diagnostic confusion with masquerading malignancies, only 10% of the cases have been diagnosed preoperatively, so as to be able to verge patients from undergoing unnecessary surgical intervention. Herein, we present a rare case of complicated diverticular abscess manifested by Actinomyces meyeri after postoperative tissue diagnosis.
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Affiliation(s)
- Kyawzaw Lin
- Internal Medicine Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, New York, USA
| | - Sithu Lin
- Internal Medicine Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, New York, USA
| | - Aung Naing Lin
- Internal Medicine Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, New York, USA
| | - Thinzar Lin
- Internal Medicine Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, New York, USA
| | - Zin Mar Htun
- Dr. Naser's Lab, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Madhavi Reddy
- GI and Hepatology, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, Brooklyn, New York, USA
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Al-Obaidy K, Alruwaii F, Al Nemer A, Alsulaiman R, Alruwaii Z, Shawarby MA. Primary gastric actinomycosis: report of a case diagnosed in a gastroscopic biopsy. BMC Clin Pathol 2015; 15:2. [PMID: 25774092 PMCID: PMC4359583 DOI: 10.1186/s12907-015-0002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Primary gastric actinomycosis is extremely rare, the appendix and ileocecal region being the most commonly involved sites in abdominopelvic actinomycosis. Herein, we report a case of primary gastric actinomycosis. The diagnosis was made on microscopic evaluation of gastroscopic biopsy specimens. To the best of our knowledge, this is the third case to be reported in the literature, in which the diagnosis was made in a gastroscopic biopsy rather than a resection specimen. Case presentation An 87-year-old Saudi male on medication for cardiomyopathy, premature ventricular contractions, renal impairment, hypertension, and dyslipidemia, presented to the emergency department with acute diffuse abdominal pain, abdominal distension, constipation and vomiting for two days, with no history of fever, abdominal surgery or trauma. The patient was admitted to the hospital with an impression of gastric outlet obstruction. Based on radiologic and gastroscopic findings, a non-infectious etiology was suspected, possibly adenocarcinoma or lymphoma. Gastroscopic biopsies showed an actively inflamed, focally ulcerated atrophic fundic mucosa along with fragments of a fibrinopurulent exudate containing brownish, iron negative pigment and abundant filamentous bacteria, morphologically consistent with Actinomyces. Conclusion Althuogh extremely rare, primary gastric actinomycosis should be considered in the differential diagnosis of radiologic and gastroscopic diffuse gastric wall thickening and submucosal tumor-like or infiltrative lesions, particularly in patients with history of abdominal surgery or trauma, or those receiving extensive medication. A high level of suspicion is required by the pathologist to achieve diagnosis in gastroscopic biopsies. Subtle changes such as the presence of a pigmented inflammatory exudate should alert the pathologist to perform appropriate special stains to reveal the causative organism.
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Affiliation(s)
- Khaleel Al-Obaidy
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Fatimah Alruwaii
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Areej Al Nemer
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Raed Alsulaiman
- Department of Internal Medicine, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Zainab Alruwaii
- King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar, 31952 Saudi Arabia
| | - Mohamed A Shawarby
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
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Triantopoulou C, der Molen AV, Es ACMGV, Giannila M. Abdominopelvic actinomycosis: spectrum of imaging findings and common mimickers. Acta Radiol Short Rep 2014; 3:2047981614524570. [PMID: 24778807 PMCID: PMC4001438 DOI: 10.1177/2047981614524570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Actinomycosis is a rare suppurative disease that may mimic other inflammatory conditions on imaging. Its invasive nature may lead to mass formation and atypical presentation thus making accurate diagnosis quite difficult. PURPOSE To describe the different aspects of abdominopelvic actinomycosis on cross-sectional imaging and indicate discriminative findings from other inflammatory or neoplastic diseases. MATERIAL AND METHODS In our study we analyzed 18 patients (15 women, 3 men; age range, 25-75 years; mean age, 50 years) with pathologically proved abdominopelvic actinomycosis. Contrast-enhanced abdominal computed tomography (CT) had been performed in all patients. Eleven patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness and enhancement degree, inflammatory infiltration, and features of peritoneal or pelvic mass were evaluated at CT. RESULTS The sigmoid colon was most commonly involved. Most patients showed concentric bowel wall-thickening, enhancing homogenously and inflammatory infiltration of pericolonic fat was mostly diffuse. In 11 patients, one or more pelvic abscesses were revealed, while a peritoneal or pelvic mass adjacent to the involved bowel segment was seen in three cases. Infiltration into the abdominal wall was seen in three cases while in one case there was thoracic dissemination. CONCLUSION Actinomycosis is related not only to long-term use of intrauterine contraceptive devices and should be included in the differential diagnosis when cross-sectional imaging studies show concentric bowel wall-thickening, intense contrast enhancement, regional pelvic or peritoneal masses, and extensive inflammatory fat infiltration with abscess formation.
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Affiliation(s)
| | | | - Ad CMG Van Es
- Radiology Department, Leiden University Medical Center, the Netherlands
| | - Maria Giannila
- Radiology Department, Konstantopouleio General Hospital, Athens, Greece
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Maddah G, Feizzdeh Kerigh B, Mohamadian N, Bagheri V. Primary urachal actinomycosis: case report and literature review. Nephrourol Mon 2013; 5:997-1000. [PMID: 24693510 PMCID: PMC3955295 DOI: 10.5812/numonthly.10933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/26/2013] [Indexed: 11/24/2022] Open
Abstract
Actinomycosis can involve all parts of the urogenital system. Urachal actinomycosis rarely reported and was mistaken with urachal adenocarcinoma. We report a case of urachal actinomycosis that presented with abdominal pain and underwent laparotomy with the diagnosis of urachal malignancy pathology reviewed the diagnosis of urachal actinomycosis. Patient had no problem in two years follow up.
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Affiliation(s)
- Ghodratolah Maddah
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Behzad Feizzdeh Kerigh
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Behzad Feizzdeh Kerigh, Department of Urology , Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118012857, Fax: +98-5118417404, E-mail:
| | - Nema Mohamadian
- Deprtment of Pathology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Vafa Bagheri
- Deprtment of Surgery, Mazandaran University of Medical Sciences, Sari, IR Iran
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Ladurner R, Bogner JR, Drosse I, Volkmer E, Sommerey S, Hohenbleicher F, Wirth S, Ozimek A, Mussack T. A rare case of primary actinomycosis of the anterior abdominal wall: diagnosis and treatment. Hernia 2008; 12:549-52. [PMID: 18401545 DOI: 10.1007/s10029-008-0344-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 12/28/2007] [Indexed: 10/22/2022]
Abstract
We present the case of a 60-year-old man who presented with a left hypochondrial swelling first noticed 4 weeks prior to admission to our clinic. Based on the findings of the ultrasound and magnetic resonance imaging investigation, a tumour of uncertain origin of the abdominal wall was suspected, also involving the small bowel. The swelling, including the affected lateral and transverse oblique muscles as well as the subcutaneous tissue and the adjacent omentum majus, was completely excised. The resulting myoaponeurotic defect of the left lateral abdominal wall was closed with interrupted Vicryl sutures and stabilised with a PTFE prosthesis (20 x 10 cm) that was placed intraabdominally and secured by spiral tackers and interrupted transfascial monofilament Prolene sutures. Microscopic examination of the excised specimen revealed an actinomycosis of the anterior abdominal wall, which is extremely rare. The surgical treatment was followed by antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications.
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Affiliation(s)
- R Ladurner
- Department of Surgery, University of Munich (LMU), Nussbaumstrasse 20, 80336, Munich, Germany.
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Hsiao HL, Shen JT, Yeh HC, Wu WJ, Wang CJ, Huang CH. Intra- and Extra-abdominal Actinomycosis Mimicking Urachal Tumor in an Intrauterine Device Carrier: A Case Report. Kaohsiung J Med Sci 2008; 24:35-40. [DOI: 10.1016/s1607-551x(08)70071-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Actinomycosis is a rare, chronic, spreading, suppurative, granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple’s operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.
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Affiliation(s)
- Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan, China
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Huang CJ, Huang TJ, Hsieh JS. Pseudo-colonic carcinoma caused by abdominal actinomycosis: report of two cases. Int J Colorectal Dis 2004; 19:283-6. [PMID: 14689208 DOI: 10.1007/s00384-003-0568-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abdominal actinomycosis is an infrequent chronic, suppurative infection caused by the aerobic gram-positive bands Actinomyces israelii. PATIENT PRESENTATION We report two cases of abdominal actinomycosis, simulating colon cancer. Before operation, both patients presented with abdominal pain and a palpable mass. Abdominal computed tomography (CT) revealed an infiltrating irregular mass in the cecum and transverse colon, respectively. Surgical intervention was then performed under the impression of colonic malignancy. CONCLUSION Postoperatively, pathologic examination confirmed the diagnosis of abdominal actinomycosis in which the characteristic finding of sulfur granules in the resected specimen was demonstrated. After surgery, the patients continued antibiotic treatment with ampicillin for 2 months at our OPD and had no signs of recurrence 1 year after surgery.
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Affiliation(s)
- Chau-Jiunn Huang
- Department of Surgery, Jiannren Hospital, 136 Nan-Yang Rd., Nan Tzu Dist., Kaohsiung, Taiwan
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Lee SH, Kim HJ, Kim HJ, Chung IK, Kim HS, Park SH, Kim SJ. Primary gastric actinomycosis diagnosed by endoscopic biopsy: case report. Gastrointest Endosc 2004; 59:586-9. [PMID: 15044907 DOI: 10.1016/s0016-5107(04)00009-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Suck-Ho Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
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Morini S, Hassan C, Lorenzetti R, Zullo A, Stella F, Cerro P. Submucosal nodules containing purulent fluid: a colonoscopic sign of actinomycosis? Gastrointest Endosc 2004; 59:319-21. [PMID: 14745418 DOI: 10.1016/s0016-5107(03)02684-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Lee IJ, Ha HK, Park CM, Kim JK, Kim JH, Kim TK, Kim JC, Cho KS, Auh YH. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology 2001; 220:76-80. [PMID: 11425976 DOI: 10.1148/radiology.220.1.r01jl1376] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the computed tomographic (CT) features of abdominopelvic actinomycosis involving the gastrointestinal tract. MATERIALS AND METHODS CT scans were analyzed in 18 patients with pathologically proved abdominopelvic actinomycosis involving the gastrointestinal tract. Eight patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness, length, bowel involvement patterns, inflammatory infiltration, and features of peritoneal or pelvic mass, if present, were evaluated at CT. RESULTS Of the gastrointestinal tract, the sigmoid colon was most commonly involved (50%). All patients showed concentric (n = 15) or eccentric (n = 3) bowel wall thickening, with a mean thickness of 1.2 cm and a mean length of 8.3 cm. The thickened bowel enhanced homogeneously in nine patients and heterogeneously in the other nine. Inflammatory infiltration was mostly diffuse and severe. In 17 patients, a peritoneal or pelvic mass (mean maximum diameter, 3.2 cm) was seen adjacent to the involved bowel and appeared to be heterogeneously enhanced in most cases; infiltration into the abdominal wall was seen in four patients. CONCLUSION Actinomycosis should be included in the differential diagnosis when CT scans show bowel wall thickening and regional pelvic or peritoneal mass with extensive infiltration, especially in patients with abdominal pain, fever, leukocytosis, or long-term use of intrauterine contraceptive devices.
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Affiliation(s)
- I J Lee
- Department of Radiology, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul, 138-736, Korea
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