Liver resection in cases of isolated hepatic actinomycosis: case report and review of the literature

Hepatic actinomycosis is an uncommon entity that forms communicating abscesses and fistulae. We report a 53-y-old immunocompetent male patient with hepatic actinomycosis. Symptoms included intermittent fever, abdominal pain, right upper quadrant tenderness and jaundice. A hepatic tumour mass was found on abdominal sonography and computerized tomography. Two preoperative percutaneous core biopsies of the mass were not diagnostic. The above findings were highly suggestive for liver abscess or purulent primary liver neoplasm. Treatment with intravenous antibiotics was continued for 20 d, but both symptoms and liver ultrasound findings remained unchanged. The patient underwent exploratory laparotomy and right posterior segmentectomy of the liver. Pathological examination of the surgically removed specimen disclosed hepatic actinomycosis. Following operation the patient remains in excellent condition without evidence of recurrence.     

Intra-abdominal actinomycosis with hepatic pseudotumor and xanthogranulomatous pyelonephritis in a 6-y-old boy

We report the case of a 6-y-old boy with actinomycosis, presenting as xanthogranulomatous pyelonephritis (XGP), hepatic pseudotumor and abdominal abscess. Symptoms included intermittent fever, abdominal pain and significant weight loss. Hepatic and renal tumor masses were suspected on sonography and computerized tomography. XGP and actinomycosis were proven by pathology. The patient recovered well with antibiotic alone.     

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.     

Successful single antibiotic therapy in actinomyces septicemia and liver abscess

Summary We are reporting on a 36-year-old man with septicemia and a liver abscess due toActinomyces sp. The infection was most probably acquired while eviscerating a deer he had shot. The possibility of an infection involvingActinomyces bovis is discussed. The liver abscess was diagnosed on the basis of non-invasive procedures. Therapy consisted of high-dose penicillin without surgical drainage of the abscess. The infection did not recur during the three-and-a-half year follow-up period. No previous reports of successful antibiotic therapy for actinomycotic liver abscess without surgical procedures are known.

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Erfolgreiche Behandlung einer Actinomyces-Septikämie mit Leberabszeß mit Antibiotikum-Monotherapie

Zusammenfassung Wir berichten über eine Septikämie mit Leberabszeß durchActinomyces sp. bei einem 36jährigen Mann. Die Infektion wurde höchstwahrscheinlich beim Ausweiden eines vom Patienten erlegten Stücks Wild erworben. Die Möglichkeit einer Infektion durchActinomyces bovis wird diskutiert. Der Leberabszeß wurde mit nicht-invasiven Methoden diagnostiziert. Die Therapie bestand aus hochdosiertem Penicillin, eine chirurgische Abszeßdrainage wurde nicht durchgeführt. Ein Rezidiv trat während einer dreieinhalbjährigen Nachbeobachtungszeit nicht auf. Bisher ist kein Fall beschrieben, in dem ein Leberabszeß durchActinomyces ohne chirurgischen Eingriff erfolgreich behandelt wurde.

     

Tumoral form of abdominal actinomycosis: a retrospective case series of seven patients

Purpose

Abdominal actinomycosis is an uncommon chronic infectious disease due to Actinomyces, a Gram-positive bacteria. This saprophytic bacteria of digestive tract and genital mucosa can occasionally become pathogenic mimicking a digestive neoplasia. The aim of this study was to underline diagnostic features of abdominal actinomycosis and to summarize data about clinical, diagnostic and therapeutic approach of this type of infection.

Patients

From January 1995 to December 2007, retrospective data concerning patients with abdominal actinomycosis who were followed-up in the University Hospital Sahloul (Sousse, Tunisia) were analysed.

Results

Seven patients with abdominal actinomycosis were identified during the study period. All presented with an abdominal mass. The diagnosis of actinomycosis was obtained after surgical resection in all cases. The histological study permitted the diagnosis in six cases, and the surgical samples grew up Actinomyces in two patients. For the five patients who received prolonged and adapted antibiotic therapy, a favourable outcome was observed.

Conclusion

Actinomycosis must be included in the differential diagnosis of invasive abdominal lesions with “malignant appearance”.     

Cervical spondylitis and spinal abscess due to Actinomyces meyeri

Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption–Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification.     

Pathophysiology of jaundice in amoebic liver abscess

Jaundice in patients with amoebic liver abscess is a frequent occurrence. However, the pathophysiology of jaundice in these patients is not fully understood. Hepatic necrosis leads to damage to bile ducts as well as various vascular structures, which in turn leads to biliovascular fistula and jaundice. We studied the mechanism of jaundice in patients with amoebic liver abscess. We prospectively evaluated 12 patients with amoebic liver abscess and jaundice from February 2002 to August 2007. All patients underwent various investigations, including imaging studies. There were 11 males and 1 female patient with a mean age of 41.3 years. Mean duration of illness before presentation was 13.8 days. All patients had fever and jaundice. We detected damaged hepatic veins and bile ducts in all patients with amoebic liver abscess causing biliovascular fistula and hyperbilirubinemia, which reverted to normal after biliary diversion with nasobiliary drainage. Jaundice in patients with amoebic liver abscess is caused by biliovascular fistula resulting from hepatic necrosis leading to damage to bile ducts and hepatic veins.     

Actinomyces graevenitzii pulmonary abscess mimicking tuberculosis in a healthy young man

Pulmonary actinomycosis is a rare disease that is often misdiag-nosed as tuberculosis or lung cancer. Actinomyces graevenitzii is a relatively new recognized Actinomyces species isolated from various clinical samples. The authors report a case of pulmonary actinomycosis caused by A graevenitzii. A computed tomography examination revealed an excavated consolidation in the middle right lobe of a previously healthy young man who presented with a long history of moderate cough. Cultures of the bronchoalveolar lavage fluid confirmed the diagnosis of pulmonary abscess caused by A gravenitzii. At the three-month follow-up consultation and, after six weeks of high-dose amoxicillin, the pulmonary lesion had completely disappeared.     

Primary hepatic actinomycosis concomitant with elevation of protein induced by vitamin K absence or antagonist II - report of a case

We report a case of primary hepatic actinomycosis showing elevation of serum protein induced by vitamin K absence or antagonist II (PIVKA-II). A 68-year-old man visited an affiliated hospital with a complaint of high fever and body weight loss. Hematological examination revealed severe inflammatory reactions and liver dysfunction. Abdominal CT showed a heterogeneous low density area composed of cystic and solid part. We suspected the cystic part with band-like enhancement to be a hepatic abscess and performed percutaneous transhepatic abscess drainage. Although inflammatory reactions decreased after the drainage, the solid part did not shrink and blood chemistry revealed elevation of PIVKA-II. Since we could not rule out the possibility of hepatoma, right hepatectomy was performed. Histological examination revealed actinomycetes. Although primary hepatic actinomycosis is a rare disease, it must be kept in mind in the differential diagnosis of the liver tumor.     

Metastatic abscess formation in a preexisting chest wall tumor: a rare initial presentation of Klebsiella pneumoniae liver abscess

The common infectious agents in the chest wall include Mycobacterium tuberculosis, Actinomyces, fungi, Nocardia, Entamoeba histolytica, and other aerobes and anaerobes. Klebsiella pneumoniae is an uncommon etiological agent. We describe a case of ankylosing spondylitis in a 45-year-old man, who had exhibited a painless lump in the left posterior chest wall for 3 months and who presented with acute-onset pain, erythematous change, and fever in the 2 weeks before admission. Cultures of the blood and chest wall abscess both showed Gram-negative bacilli, which were classified as K. pneumoniae. A contrast-enhanced computed tomography scan of the abdomen revealed a nonenhancing cystic abscess measuring 4.9 × 6.5 × 6.4 cm in segment 6 of the liver and communicating with the chest wall. Drainage of the liver abscess under ultrasound guidance and open surgical drainage of the chest wall abscess combined with adequate antibiotic treatment resolved the abscess.     

Actinomycosis after allogeneic hematopoietic stem cell transplantation despite penicillin prophylaxis

Actinomycosis is a rare chronic and multifaceted disease caused by Actinomyces species frequently mimicking malignancy or other chronic granulomatous lung diseases. We report 4 original presentations of actinomycosis arising under supposed penicillin prophylaxis in allogeneic stem cell transplantation recipients.     

Actinomycotic liver abscess: A rare complication of colonic diverticular disease

We present the first case of hepatic actinomycosis requiring both medical and surgical intervention due to liver dissemination from a primary colonic abscess. A 52-year-old white male had a computerised (CT) abdominal scan following an episode of collapse and was found to have peri-colonic and hepatic abscesses. Prior to this episode, he suffered with a two month history of fever, unexplained weight loss, and anaemia suggesting possible malignancy. He was treated with both radiological and surgical drainage of the abscesses, alongside the antibiotic cover and underwent an anterior colonic resection with primary anastomosis. There have been no previous reports of an actinomycotic liver abscess complicating colonic diverticular abscess. A multi-team approach is recommended when disseminated actinomycotic infection is encountered.     

Liver abscess in patients with cirrhosis of the liver: a 12-year experience

Purpose. Liver abscess is rare in patients with cirrhosis of the liver. The aim of this retrospective study was to investigate the incidence, clinical presentation, causal pathogens, and outcome of liver abscess in cirrhotic patients. Methods. We collected 21 liver abscess specimens (from 14 male patients and 7 female patients; Child A: B: C, 4: 7: 10) from 22 731 admissions of 6450 cirrhotic patients, from 1986 through 1998. Results. The common clinical symptoms and signs included fever, chills, and abdominal tenderness. The major predisposing factors were biliary tract disease (52%) and diabetes mellitus (48%). The diagnosis rate with abdominal ultrasonography was 79%. Gram-negative aerobes were the predominant pathogens (Klebsiella pneumoniae, 66.7%; Escherichia coli, 23.8%), and occurred in 80% and 69% of blood and pus cultures, respectively, while 38% of cases showed polymicrobial pathogens. The location of the abscess was predominantly in the right lobe (71.4%), and 47.6% of patients had multiple abscesses. Six patients died (all with Child C cirrhosis). The overall mortality rate was 28.6% (6/21). Conclusions. The incidence of liver abscess in the cirrhotic patients was low, at 0.09% (21/22 731 admissions). The clinical presentations and pathogens were not different from those in noncirrhotic patients, except that in our cirrhotic patients, there was no significant difference in mortality between those with monomicrobial and those with polymicrobial abscess; nor was there a significant difference in mortality between those with single and those with multiple abscesses. The Child C patients were the high-risk group. Received: November 6, 2000 / Accepted: February 2, 2001     

Hepatic actinomycosis: Report of one case and analysis of 32 previously reported cases

Hepatic actinomycosis is rare,with few published cases.There are no characteristic clinical manifestations,and computed tomography(CT)shows mainly low-density images,making clinical diagnosis difficult,and leading to frequent misdiagnosis as primary liver cancer,metastatic liver cancer or liver abscess.Diagnosis normally requires examination of both the aetiology and pathology.This article reports one male patient aged 55 who was hospitalized because of repeated upper abdominal pain for more than 2 mo.He exhibited no chills,fever or yellow staining of the skin and sclera,and examination revealed no positive signs.The routine blood results were:haemoglobin 110 g/L,normal numbers of leukocytes and neutral leukocytes,serum albumin 32g/L,negative serum hepatitis B markers and hepatitis C antibodies,normal tumour markers(alpha-fetoproteinand carcinoembryonic antigen).An abdominal CT scan revealed an 11.2 cm×5.8 cm×7.4 cm mass with an unclear edge in the left liver lobe.The patient was diagnosed as having primary liver cancer,and left lobe resection was performed.The postoperative pathological examination found multifocal actinomycetes in the hepatic parenchyma,which was accompanied by chronic suppurative inflammation.A focal abscess had formed,and large doses of sodium penicillin were administered postoperatively as anti-infective therapy.This article also reviews 32 cases reported in the English literature,with the aim of determining the clinical features and treatment characteristics of this disease,and providing a reference for its diagnosis and 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.     

Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae

Klebsiella pneumoniae (KP) is the most common cause of pyogenic liver abscess in eastern Asia. KP liver abscess commonly presents as a single large abscess with a predominantly solid consistency. It is sometimes unsuitable for percutaneous catheter drainage because of the poorly liquefied contents. Antibiotic therapy alone may raise a probability of treatment failure and occurrence of complications such as abscess rupture. Hepatic or portal venous thrombosis, hematogenous spread, and spontaneous rupture also occur frequently. We report a case of KP liver abscess with a typical solid appearance, complicated by disseminated intravascular coagulation, spontaneous rupture, and pyogenic spondylitis.     

A case of hepatic actinomycosis diagnosed by thin needle aspiration biopsy successfully treated with antibiotics]

A 57-year-old man presented with chief complaints of right hypochondrial pain and fever. Laboratory tests revealed severe inflammatory reactions. Abdominal ultrasonography disclosed a mass with non-homogeneous internal echoes suggesting hepatic abscess. Percutaneous liver biopsy revealed a lump of actinomycetes, allowing a diagnosis of hepatic actinomycosis. The abscess disappeared following long-term treatment with penicillin antibiotics. Actinomycosis developing primarily in the liver is very rare. This condition needs to be distinguished from tumorous lesions of the liver, including malignancy. It seems noteworthy that the diagnosis of this condition was possible on the basis of percutaneous liver biopsy.     

Hepatic abscess induced by foreign body： Case report and literature review

Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.     

Liver abscess complicating transcatheter arterial embolization: a rare but serious complication. A retrospective study after 3878 procedures

OBJECTIVES: Liver abscess is one of the complications of transcatheter arterial embolization (TAE) for hepatocellular carcinoma. We studied the clinical features and analysed the incidence, risk factors, helpful clinical clues, culture profiles and predictive factors of post-TAE liver abscess. The influence of abscess development on the evolution of the tumour process was also studied. METHODS: We retrospectively reviewed records of 3878 TAE procedures performed over a 6 year period. RESULTS: Ten cases of liver abscess developed in nine patients (eight males and one female). The incidence was 0.26% (10 episodes/3878 procedures). The main clinical presentations included fever (91.7%), chills (50%) and abdominal pain (33.3%). All but one febrile patient presented fever in a recurrent form. The positive culture rates were 41.7% for blood and 83.3% for pus. Gram negative bacteria were found in 80% of blood cultures and 68% of pus cultures. Polymicrobial infections were encountered in 60% of the blood cultures and 70% of pus cultures. Management included antibiotics, drainage and operation. Four patients died due to the direct complications of liver abscess. One patient experienced total tumour resolution after successful treatment for liver abscess. Patients with larger liver abscesses and patients with greater age carried higher mortality rates. CONCLUSIONS: Liver abscess is a rare complication after TAE for hepatocellular carcinoma. Recurrent fevers after an initial symptom free interval should arouse suspicion of an abscess. The mortality is high and a large abscess and higher age predict an unfavourable outcome. Abscess formation can lead to complete tumour resolution.     

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.