Primary actinomycosis of the abdominal wall. Description of 2 cases and review of the literature

We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actinomycosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneous needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adequated treatment.     

Pulmonary actinomycosis diagnosed through transbronchial lung biopsy (TBLB)]

Pulmonary actinomycosis is a rather rare chronic pulmonary infection. Its diagnosis may be difficult without biopsy, because its culture from sputum or bronchial secretion is rarely successful. We report a case of pulmonary actinomycosis diagnosed by means of TBLB. A 57-year-old man was admitted to our hospital because of hemosputum. The chest radiograph at the first visit revealed a nodular lesion in the right middle lobe. The biopsy examination showed sulfur granules of which PAS-positive mycelium was arranged in a radiating pattern. On the basis of these findings, we diagnosed pulmonary actinomycosis. So far, there have been only 4 reported cases of pulmonary actinomycosis diagnosed by TBLB in Japan. TBLB is worth trying in the diagnosis of pulmonary actinomycosis, because it can avoid surgical procedures, if successful.     

Cervicofacial actinomycosis: Diagnosis and management

Cervicofacial actinomycosis is an uncommon but fascinating infection of the head and neck. Most cases are odontogenic in origin and occur predominantly in immunocompetent individuals. Causative microorganisms are generally of low pathogenicity and cause disease only in the setting of antecedent tissue injury. The disease process is characterized by the formation of abscesses, fibrosis and woody induration of tissues, and draining sinuses that discharge "sulfur granules." Cultural isolation of Actinomyces species from clinical specimens, or microscopic visualization of grampositive, non-acid-fast, thin, branching filaments in cytologic aspirates or histopathologic sections are the best methods of diagnosis of cervicofacial actinomycosis. Penicillin is the drug of choice and is usually administered for 2 to 12 months, although short-course treatment may cure uncomplicated infection. Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts, and drainage of soft tissue abscesses. The prognosis for treated infection is excellent.     

肺放线菌病一例并文献复习

目的 提高对肺放线菌病发病机制、诊断、临床特点及治疗的认识.方法 报道2007年3月解放军总医院附属第一医院呼吸科收治的1例肺放线菌病病例并进行相关文献复习.结果 患者女,66岁.反复出现咳嗽、咳痰、低热4年,多次X线胸片均示右中叶肺炎,经支气管镜检查及病理诊断为肺放线菌病.经林可霉素联合磺胺甲嚼唑/甲氧苄啶治疗6个月后痊愈.结合本例并复习近20年国内外文献报道的187例肺放线菌病(国外162例,国内25例)资料,结果 显示本病男性多见,发病年龄为12～87岁;咳嗽、咳痰、胸痛为常见症状,咳黄色颗粒样物为典型表现,但并不多见.胸部CT可表现为实质团块影、片状影、实变影伴支气管充气征、空洞、纵隔淋巴结肿大、胸腔积液及胸膜增厚等.病变部位以左下叶及右中叶居多,与肺癌、肺结核易混淆.确诊主要依靠经支气管镜活检病理及手术病理检查,痰涂片及培养阳性率低.青霉素、四环素、红霉素、磺胺类或林可霉素等抗生素治疗及手术切除是主要的治疗手段.结论 肺放线菌病是一种少见病,早期诊断和治疗可获得良好疗效.     

Primary Gastric Actinomycosis: A Case Report and Review of the Literature

A case of primary gastric actinomycosis presenting as a bleeding gastric tumor is reported. The diagnosis of this infection of the stomach is difficult and may often be established only by histological examination. If the disease is recognized, the prognosis is good because antibiotic treatment is very effective. Recent literature findings are reviewed and clinical and endoscopic features are compared.     

Simultaneous presentation of actinomycosis and metastatic pharyngeal carcinoma

Although actinomycosis frequently presents as a pseudotumoral syndrome, the simultaneous diagnosis of actinomycosis and cancer is exceptional. Actinomycosis can occur as an opportunistic infection secondary to the antineoplastic treatment and even the cancer itself can act as facilitating factor. We report a patient who was diagnosed simultaneously of advanced oropharinx cancer (T4-N1-M0) and actinomycosis associated to the tumoral mass. This exceptional association and the importance of its early diagnosis justify the communication of the case.     

Primary endobronchial actinomycosis simulating endobronchial tuberculosis in a patient with diabetes mellitus

Primary endobronchial actinomycosis is rare and very uncommon without foreign body aspiration. A 70-years old nonsmoker diabetic woman was presented with hemoptysis and weight loss for two months. Fiberoptic bronchoscopy was performed because of hilar mass on her computerized tomography scan, with a presumptive diagnosis of bronchial carcinoma. It demonstrated vegetations in left upper lobe bronchus. Histologic examination of the biopsy specimen demonstrated Actinomyces infection. The patient responded well to penicillin therapy and chest X-ray completely cleared in four months. To our knowledge, the association of endobronchial actinomycosis with diabetes mellitus without presence of a foreign body has not been reported previously, and should be included in differential diagnosis with endobronchial tuberculosis or cancer in endobronchial vegetations.     

Intra- and extra-abdominal actinomycosis mimicking urachal tumor in an intrauterine device carrier: a case report

Actinomycosis is a rare, chronic suppurative infection caused by the Gram-positive anaerobic filamentous bacterium, Actinomyces israeli. In most cases, the diagnosis is made postoperatively because of its unusual clinical presentation. Abdominal actinomycosis is the second most common site of the disease and may mimic abdominal cancer, inflammatory bowel disease or diverticulitis. The abdominal-pelvic form of this disease mostly results from the prolonged use of an intrauterine device. We report a rare case of combined intra- and extra-abdominal actinomycosis mimicking urachal tumor that was diagnosed by computed tomography, which presented as two tender abdominal palpable masses following long-term intrauterine device use. The disease was confirmed by postoperative histopathologic examination, which revealed sulfur granules microscopically, and was successfully treated by complete surgical resection following a period of appropriate antibiotic treatment.     

Actinomycosis, A Rare and Unsuspected Cause of Anal Fistulous Abscess: Report of Three Cases and Review of the Literature

. Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte. Male gender and diabetes are risk factors, but the exact pathogenic mechanism remains speculative. The diagnosis is a challenge and often delayed, with a protracted history of masses and sinuses extending into the gluteal and genital region. The treatment, a combination of surgery and antibiotics, is poorly standardized. We report three cases and compare their characteristics to those of published cases, found by a computerized literature search (1968–2002).The lesions, a simple fistula-in-ano or a mass, were diagnosed in an early stage in all three patients. The infection always spread into the scrotum. There were no risk factors other than gender, except in one patient. The diagnosis was suspected by the observation of draining sulfur granules and promptly confirmed by histology in the three cases. All patients healed with antibiotics in addition to simple surgical procedures. Treatment consisted of amoxicillin for two weeks in two cases and more extended antimicrobial treatment in the third. These findings are contrasting with the classic picture of perianal actinomycosis.It is concluded that perianal actinomycosis can occur in the absence of risk factors and that early diagnosis requires a high degree of suspicion. An infection with Actinomyces should be suspected in the presence of lesions containing watery purulent material with sulfur granules. The indication for extended antibiotherapy combined with sphincter damaging surgery may need to be revised in the presence of early detection.     

Perianal abscess caused by Actinomyces: report of a case

Most anal abscesses are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. The treatment comprises excision of the abscess and. if appropriate, fistulectomy. Primary anorectal actinomycosis and perianal actinomycosis are very rare and are caused by Actinomyces, which is a ubiquitous microaerophilic bacterium. Here we report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever or leucocytosis with normal routine blood tests. After excision sulphur granules drained from the cavity and the pathological investigations were indicative of perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After elimination of other diagnoses, e.g. Crohn’s disease, tuberculosis and malignant growths, this rare case of perianal actinomycosis should be kept in mind in the differential diagnosis of a painless perianal mass.     

Abdominopelvic actinomycosis in pseudo-tumoral form: diagnosis by ultrasonography-guided biopsy]

The authors report a case of abdominopelvic actinomycosis, a rare bacterial infection. This case is exceptional for its clinical tumoral expression with fistulization through the skin, and for its rapid diagnosis by ultrasonically-guided needle biopsy. The clinical, bacteriological, histological and therapeutic aspects of actinomycosis are detailed.     

Primary hepatic actinomycosis

Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.     

Pseudo-colonic carcinoma caused by abdominal actinomycosis: report of two cases

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.     

Primary gastric actinomycosis: A case report.

Gastric actinomycosis is an extremely rare disease. To date, about 20 cases have been reported in the literature. In most cases, diagnosis was made by histopathologic evaluation of an operative specimen. We report here a 68-year-old man with primary gastric actinomycosis who was admitted to the hospital with upper gastrointestinal bleeding and diagnosed as actinomycosis by microscopic examination of biopsy specimens obtained by endoscopy. This case is reported because of the rarity of endoscopically diagnosed primary gastric actinomycosis.     

Actinomycosis: an often forgotten diagnosis

We report a case of actinomycosis presenting as a chest wall mass in a 35 year-old man. Thoracic actinomycosis poses a diagnostic challenge to clinicians not only because it is uncommon and often forgotten, but also because culture of the causative microbes is technically difficult. The classic microscopic appearance of this Gram-positive bacteria associated with surrounding sulfur granules often forms the basis of diagnosis.     

Actinomycose abdominale avec une localisation colique

Abdominal actinomycosis is an infrequent chronic, suppurative infection caused by the aerobic grampositive bands Actinomyces israelii. Cervical and thoracic locations are frequently reported. We report one case of abdominal actinomycosis, simulating colon cancer. the patient which was 58 year old presented with abdominal pain and a palpable mass. Surgical intervention was performed under the impression of colonic malignancy. 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 patient continued antibiotic treatment and had no signs of recurrence.     

Actinomycosis as a rare cause of vertebral osteolysis

Actinomycosis is an uncommon entity caused by an anaerobic bacterium, Actinomyces species, most often Actinomyces israelii. We present a patient who suffered from progressive lumbar pain and high fever. Actinomycosis infection was diagnosed after extensive radiological and pathological evaluation. Treatment with i.v. ampicillin was started, followed by oral antibiotics for one year. This paper gives an overview of the different clinical presentations of actinomycosis infection, with special attention to the skeletal involvement. We also discuss diagnosis and treatment. The clinical picture can mimic several other conditions, such as lymphomas. Delay in diagnosis and treatment can significantly worsen the condition of the patient.     

Professor Ahmed Shafik (1933–2007)

Most cases of anal abscess are caused by anal fistula and invasion of the surrounding tissues by a mixed colonic flora. Treatment consists of excision of the abscess and, in case of fistula, fistulectomy. Primary anorectal and perianal forms of actinomycosis are very rare and caused by actinomyces, as ubiquitous anaerobics bacterium. We report a case of perianal actinomycosis. The patient had a short history of painless perineal induration without fever and leukocytosis with normal results at routine blood examination. After excision, sulfur granules drained from the cavity and pathological investigations indicated perianal actinomycosis. Appropriate surgery and antibiotic treatment healed the perianal infection. After exclusion of possible diagnoses such as Crohn’s disease, tuberculosis and malignant growths, the rare case of perianal actinomycosis should be considered in the differential diagnosis of painless perianal masses.     

Actinomycosis of the pelvis with an indwelling IUD

Infection with actinomycosis israeli (an anaerobic, gram-positive bacterium) presents as chronic inflammation with tendency to fibrosis and suppuration with formation of external sinuses. Cervicofacial, thoracic and abdominal forms of the disease made up 95% of cases of actinomycosis. A 53-year-old woman was admitted to the hospital because of a pelvic mass which was thought to be malignant. A laparotomy was performed and the histologic examination showed actinomycosis. The patient first received penicillin followed by tetracyclin and the pelvic mass shrunk. One year later no more mass was detectable. We think that the IUP in place over years is the source for this infection.     

Primary endobronchial actinomycosis associated with broncholithiasis

Primary endobronchial actinomycosis is an extremely rare disease that presents with endobronchial mass. We report 2 cases of primary endobronchial actinomycosis associated with broncholithiasis. There was no foreign body material, suggesting that these broncholiths were formed endogenously. Even though it is very rare, endobronchial actinomycosis should be included in the differential diagnosis of calcified endobronchial mass, especially when there is no clinical or radiological evidence of a granulomatous infection, such as tuberculosis, and the yellowish materials obstructing the bronchi are seen during bronchoscopy.