Abdomino-pelvic actinomycosis. Report of 2 cases

Actinomycosis is a chronic, granulomatous, suppurative and fistulasing infection related to a gram-positive bacteria (actinomyces israeli). Cervico-facial actinomycosis is the most common localization. The prevalence of abdomino-pelvic actinomycosis is increasing mainly with the increase of the use of intrauterin device. Its clinical presentation is variable and may mimic cancer or tuberculosis. The diagnosis of abdomino-pelvic actinomycosis is hard and most of the cases are detected during surgical exploration. We report two cases of abdomino-pelvic actinomycosis; in the first case, the disease was extended to the caecum and the abdominal wall. The skin biopsies made the diagnosis of actinomycosis, avoiding surgery. In the second case, the diagnosis of actinomycosis is made post operatively because of high suspicion of pelvic cancer. Through these two observations, we review pathogenesis of the disease, its clinical aspects and its diagnostic and therapeutic means.     

Efficacy of doxycycline in thoracic actinomycosis: a case report

The authors present a case of thoracic actinomycosis in a 32 year-old man with a history of cervico-facial actinomycosis. Diagnosis was made by bacterial examination of purulent drainage from sternal wound showing typical sulfures granules. One year course of doxycycline gives clinical and radiological improvement.     

Uterine perforation with Lippes loop intrauterine device-associated actinomycosis: a case report and review of the literature

A case of a 67-year-old postmenopausal woman, gravida 2, para 2, with an uterine perforation from actinomycotic infection with Lippes loop IUD is reported. She had the Lippes loop IUD inserted for 35 years, and had never had any pelvic examination nor Papanicolaou smear. She presented with acute abdominal pain. The clinical picture mimicked peptic ulcer perforation. The woman underwent laparotomy and exudative fluid was discovered in the abdominal cavity with the tip of the Lippes loop IUD at one of the two small holes of the uterine fundus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The postoperative microscopic pathological report demonstrated characteristics of actinomycosis. She was treated with parenteral high-dose penicillin for 4 weeks followed by oral penicillin for 6 months. The woman had an uneventful recovery. To our knowledge, this is the first case report of uterine perforation due to Lippes loop IUD-associated actinomycotic infection.     

Orf: a case report

Ecthyma contagiosum (orf), a viral disease endemic to sheep and goats, can be zoonotically transmitted to humans through contact with infected animals. While the disease is common among sheep and goat herders worldwide, it comes to medical attention infrequently since it is generally a mild self-limited illness. We recently treated a healthy 36-year-old female who presented with bullous lesions on her fingers and a diffuse macular rash which had developed after antibiotic therapy for her bullae. She had been caring for her neighbor's goats which had recently been ill with "sore mouth." We discuss this case of orf and review the medical literature on this self-limited illness uncommon to the midwestern United States.     

Tungiasis: a case report

This is a case report of a patient who developed a nodule in one foot, which upon biopsy, was diagnosed as tungiasis, a cutaneous infestation caused by a human flea. The natural life cycle, clinical and pathological expressions are discussed.     

Perianal actinomycosis: a case study of this rare infection associated with nicorandil usage

Perianal actinomycosis infection is a very rare occurrence and is challenging to diagnose. Nicorandil is a potassium channel agonist, which is used in the treatment of ischaemic heart disease. Its usage is associated with perianal ulceration and delayed surgical wound healing. We report a case of actinomycosis complicating a chronic perianal ulcer, which was associated with long-term nicorandil usage. It raised the suspicion of malignancy and required over six months of antimicrobial treatment to achieve satisfactory healing. Perianal actinomycosis results in chronic infection which spreads across tissue planes and can resemble an ulcerated malignancy. Nicorandil usage can result in perianal ulceration and produces conditions which are conducive to actinomycosis infection. In such cases, nicorandil therapy should be discontinued, if possible, and long-term systemic antibiotics form the mainstay of treatment.     

Endometrial actinomycosis. Two case reports]

Actinomyces is an aerobic, Gram positive bacteria saprophyte of the genital tract. The endometrial involvement is extremely rare. The authors report two cases of pelvic actinomycosis in a 58 and 55 year old women, the second using intrauterine device for 11 years.     

Harlequin fetus: a case report

The authors report a case of "harlequin fetus" which was brought to their attention. The report was justified not only by the rarity of the disease, but above all because, after having examined the literature on the topic, this appears to be the third case treated with etretinate. The case in question was a female affected by congenital ichthyosis in its total form and by initial necrosis of the extremities. Etretinate treatment gave good results in terms of cutaneous modifications: reduction of hyperkeratosis, disappearance of ectropion and eclabium. Therefore, although the patient died when 16 days old due to sudden renal insufficiency, the case confirms the two previous reports on the value of this therapy.     

Weanling diarrhea: a case report

This case report describes a 14-month-old Guatemalan boy suffering from diarrhea and malnutrition. He had been healthy and experienced normal growth until weaning, which began at six months of age. Introduction of semisolid foods at this time was accompanied by bouts of diarrhea and a reduced growth rate. After admission to hospital at 14 months of age, he was found to have protein-energy malnutrition of the edematous type (kwashiorkor) and to be infected with Giardia lamblia. Therapy with metronidazole and a high-protein diet resulted in satisfactory weight gain and cessation of the diarrhea.     

Iliac chondroma: a case report

Chondroma is a benign bone tumour that usually occurs in the in carpal and phalangeal bones. The iliac involvement is very rare and should be differentiated from chondrosarcoma. The authors report a case of iliac chondroma revealed by an acetabular lytic area in a 13-year-old girl. The diagnosis of chondroma was confirmed after surgical biopsy.