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Everett M, Kheraj A, Redfield J, Ahmed NS, Kumar A, Kothadia JP. Spontaneous Bacterial Peritonitis Because of Actinomyces. ACG Case Rep J 2024; 11:e01353. [PMID: 38706452 PMCID: PMC11068148 DOI: 10.14309/crj.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Abstract
Actinomycosis is a rare chronic granulomatous disease that manifests with nonspecific symptoms of abdominal pain, anorexia, and weight loss. The disparity in the presentation of this condition presents a tremendous diagnostic challenge. There are few reports of Actinomyces species causing spontaneous bacterial peritonitis without previous localized masses or abscesses have been published. We provide a case of spontaneous bacterial peritonitis secondary to Actinomyces species in a 46-year-old woman with uterine fibroids and a lack of preceding abscess. Although rare, spontaneous bacterial peritonitis because of Actinomyces should be considered in differential in female patients without pre-existing liver disease presenting with spontaneous bacterial peritonitis.
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Affiliation(s)
- Matthew Everett
- The University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Anusha Kheraj
- The University of Tennessee Health Science Center, College of Medicine, Memphis, TN
| | - Jordan Redfield
- Division of Gastroenterology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Nazneen S. Ahmed
- Division of Gastroenterology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Aneel Kumar
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Jiten P. Kothadia
- Division of Gastroenterology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
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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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Ze-Ying L, Hao Z, Ru-Li F, Yu-Jun D, Xiao-Ping C. A case of Nonomuraea blood infection, Beijing, China. Clin Microbiol Infect 2023; 29:1342-1344. [PMID: 37354995 DOI: 10.1016/j.cmi.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Liang Ze-Ying
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Zheng Hao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Nosocomial Infection, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Ru-Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Dong Yu-Jun
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Chen Xiao-Ping
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Department of Nosocomial Infection, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Saad AA, Ragab Y, Ahmed ES, Emad Y, Alghamdi FA, Taha I, Rasker JJ, Saad AA. Pelvi-abdominal as a complication of long-term use of intrauterine device (IUD). The important role of imaging in diagnosis and follow-up. Radiol Case Rep 2022; 17:4286-4290. [PMID: 36124319 PMCID: PMC9482080 DOI: 10.1016/j.radcr.2022.08.035] [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] [Received: 07/28/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
ACTINOMYCOSIS is a rare chronic granulomatous disease caused by anaerobic filamentous gram-positive bacteria, the most common of which is Actinomyces israelii. Actinomycetes are commensal inhabitants of the oral cavity and gastrointestinal tract, but they may become pathogenic through invasion of breached or necrotic tissue. Pelviabdominal ACTINOMYCOSIS is uncommon and can mimic a variety of disease processes, including abdominal mass mimicking malignancy, acute abdomen, asthenia, and weight loss. We describe a 38-year-old woman who presented with acute abdominal pain and tenderness, as well as constitutional manifestations and elevated inflammatory markers. On initial computerized tomography (CT) and MRI, a large fluid collection underlining the anterior abdominal wall at the false pelvic cavity, as well as parietal peritoneal enhancement and smudging of the mesenteric fat and a bulky fibroid uterus with an implanted IUD, were identified. The ultrasound guided aspiration and anaerobic culture revealed positive growth for Actinomyces bacteria. An exploratory laparoscopy revealed extensive adhesions between the abdominal wall and the small intestine, as well as hyperemic and thickened peritoneum, and peritoneal biopsy confirmed ACTINOMYCOSIS. After the diagnosis was established, the IUD was removed and the patient was given Ceftriaxone 2 gm once daily for 6 weeks before switching to oral doxycycline 100 mg twice daily for another 3 months. A significant regression of the suprapubic fluid collection, and peritoneal-mesenteric changes were confirmed on follow-up. The case is discussed, and the relevant literature reviewed and analyzed.
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Affiliation(s)
- Ahmed Ahmed Saad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Ragab
- Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, Cairo, 11562, Egypt
| | - Eiman Saeed Ahmed
- Internal Medicine Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Yasser Emad
- Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, Cairo, 11562, Egypt
| | - Fahad Ali Alghamdi
- Department of Pathology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Islam Taha
- Internal Medicine Department, Dr. Erfan and Bagedo General Hospital, Jeddah, Saudi Arabia
| | - Johannes J. Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerloolaan 5, 7522NB, Enschede, The Netherlands
- Corresponding author.
| | - Amr Ahmed Saad
- General Surgery Department, New Cairo Central Hospital, Cairo, Egypt
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Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease. Life (Basel) 2022; 12:life12030447. [PMID: 35330198 PMCID: PMC8954618 DOI: 10.3390/life12030447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.
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