Intrauterine Device-associated Actinomycosis Simulating Pelvic Malignancy

We describe pelvic and rectal actinomycosis in a patient with an intrauterine contraceptive device. The presentation was that of an indolent, noninfectious process which mimicked a pelvic malignancy. As in many cases of pelvic actinomycosis, the diagnosis was not suspected preoperatively. Moreover, suppurative disease progressed despite removal of the intrauterine device. In patients who have intrauterine contraceptive devices or who have had them removed recently, abdominal pain, recurrent vaginal bleeding or adnexal masses should prompt a diligent search for potentially pathogenic Actinomyces in the genital tract.     

Abdominal manifestations of actinomycosis in IUD users

The use of an intrauterine device (IUD) is associated with the presence of actinomyces in the female genital tract. Since IUD use is currently so prevalent, IUD-related pelvic inflammatory disease occasionally spreads to the rest of the abdomen. Two patients with abdominal actinomycosis in association with an IUD illustrate the problem; we review the general problem.     

Ileo-caecal actinomycosis: report of a case simulating complicated inflammatory bowel disease

Abdominal actinomycosis is a rare infectious disease caused by Actinomyces israelii, a gram-positive anaerobic saprophyte germ that is a normal inhabitant of the upper intestinal tract in humans. Actinomyces israelii rarely cause abdominal infections or actinomycosis. Abdominal actinomysosis is characterised by fistulae and abscesses and may mimic cancer or inflammatory bowel disease. Abdominal actinomycosis is difficult to diagnose preoperatively, and often require surgical removal of the diseased tissue, allowing pathologists for giving the definitive diagnosis, revealed by characteristic "sulfur granules". The authors report herein the case of a 47-year-old man who presented with diarrhoea and abdominal pain. Abdominal computed tomography evoked complicated inflammatory bowel disease and surgical procedure was decided. Laparoscopic exploration did not provide further significant information, and laparotomy with diseased bowel resection was performed. Pathology demonstrated "sulfur granules" and allowed the diagnosis of abdominal actinomycosis. This case demonstrated that abdominal actinomycosis should be included in the differential diagnosis when computed tomography shows an infiltrative and inflammatory mass.     

Abdominal actinomycosis: Barium enema and computed tomography findings

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manufestation of these symptons. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.     

女性盆腔结核性包块的诊断及治疗

女性盆腔结核性包块是临床上较常见的妇科疾病,容易与其他盆腔包块和肿瘤相混淆,造成误诊或漏诊。在临床工作中,为提高对女性盆腔结核性包块诊断的准确性,应全面、综合分析患者病史、症状,完善有关的辅助检查,包括结核菌素试验、病原学检查、诊断性刮宫、血清癌抗原125检测、腹腔积液及影像学检查;诊断方法上有结核病免疫学诊断、分子生物学检查,为肺外结核的诊断提供了快速检查技术;对诊断困难者进行腹腔镜或剖腹探查术也是必要的。女性盆腔结核性包块需要与盆腔炎性疾病、卵巢子宫内膜异位囊肿、卵巢良恶性肿瘤,尤其应与卵巢癌进行鉴别;也需要与腹腔其他恶性肿瘤以及其他发热性疾病鉴别。女性盆腔结核性包块治疗上主要是全身化学治疗,对临床高度怀疑生殖器结核患者可行诊断性治疗;必要时辅以手术治疗,术中注意防止损伤发生;对结核中毒症状严重者可考虑加用糖皮质激素治疗。     

A case study of female genital tuberculosis in a Western European setting

We have studied five women with genital tuberculosis (TB), which is an uncommon disease in Western European countries. However, young women that have emigrated from a country with high TB-prevalence and have complaints of unexplained infertility and nonspecific abdominal or pelvic symptoms should be checked for this disease. Because genital tuberculosis frequently causes infertility, early diagnosis and treatment are crucial, necessitating rapid microscopic, histological, and microbiological (culture) testing in suspected cases.     

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”.     

Prise en charge diagnostique et thérapeutique de la tuberculose urogénitale

Genito-urinary tuberculosis is the fourth most common manifestation of the disease, but it is often underestimated by clinicians because of few and non-specific symptoms and insidious disease course. The most common urinary findings are multiple ureteral stenosis. The most common genital involvement is an epididymal nodule for men and a chronic salpingitis for women. The definite diagnosis of genito-urinary tuberculosis is obtained on the basis of culture studies. Due to the paucibacillary nature of the disease, especially of genital location in woman, a probable or presumptive diagnosis is frequently considered with several parameters including radiological imaging (abdominal CT-scan, pelvic ultrasound, pelvic MRI). Endoscopic and surgical procedures are frequently required to obtain specimens for histopathologic and bacteriological studies. Medical treatment is the method of choice, with a combination of four drugs, namely isoniazid, rifampicin, ethambutol and pyrazinamide, followed by a two-drug regimen, for a total of six month duration. Surgery might be indicated in complicated genito-urinary tuberculosis (decreased renal function, infertility, urologic complaints).     

Rare presentation of actinomycosis as an abdominal mass

PURPOSE: The purpose of this article was to report an unusual presentation of abdominal actinomycosis masquerading as a tumor. METHODS: The patient was a 54-year-old male who presented with vague abdominal discomfort and a palpable left lower quadrant mass defined on CT scan. Multiple intraoperative core biopsies were nondiagnostic, and he underwent en bloc resection of the mass and adjacent organs for a presumed tumor. RESULTS: Examination of tissue from deep within the excised specimen revealed sulfur granules diagnostic for actinomycosis. CONCLUSION: Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy. This novel presentation and a review of the literature are reported.     

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.     

Actinomycose pelvienne pseudotumorale : à propos de deux cas

Introduction

Pelvic actinomycosis is a rare suppurative disease that should be included in the differential diagnosis of gynecological cancers.

Case reports

We report two women aged 40 and 41 years with pelvic tumor-like actinomycosis. Physical examination disclosed a pelvic mass in both cases. CT-scan showed annexial infiltrative tumor in both cases with liver metastasis and peritoneal carcinosis in one case each. Surgical procedure consisted in right annexectomy in one case and peritoneal biopsy in the other. Pathologic diagnosis was diagnostic of actinomycosis. Both patients were treated by penicillin G 20 million IU/day during two weeks and then by amoxicilline 3 g/day per day during six months. Clinical outcome showed significant improvement in both cases with complete regression of hepatic and pelvic lesions on CT-scan in one case.

Conclusion

Pelvic actinomycosis is a rare suppurative disorder, commonly associated with a long term wearing of intra-uterine device. Diagnosis is difficult, often delayed and pelvic actinomycosis could mimic gynaecologic neoplasia.     

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.     

Spontaneous peritonitis attributed to actinomyces species

Abdominal actinomycosis is a rare condition caused by actinomyces species found in the normal flora of the oral cavity, gastrointestinal and genital tract. All cases reported describe localized forms demonstrating masses, pseudotumors or abscess during surgery or radiology studies and there are no reports about spontaneous peritonitis caused by actinomycetes. We report a case in which this disease present as symptomatic ascitic fluid infection refractory to antimicrobial therapy for intra- abdominal sepsis and detected during unsuspected cytology test. The case was successfully treated with a penicillin regimen. As a spontaneous peritonitis variety, the microbiology diagnosis remains difficult as we don't think in this form of abdominal actinomycosis not described previously in the literature. The present illustrative case strength the usefulness of cytology test in patients with suspected ascitic fluid infection refractory to a medical therapy.     

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.     

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.     

Genital tuberculosis and surgical treatment of it

The paper presents the specific features of diagnosis and clinical course of genital tuberculosis under the present conditions. It shows it expedient to make a differential diagnosis of genital tuberculosis in 2 steps: 1) the use of the routine examination and 2) the study of specific antituberculous immunity. Genital tuberculosis risk groups to be obligatorily examined at a specialized tuberculosis control facility are identified. The specific features of the clinical course of genital tuberculosis, such as aptness to exudative processes, a combination with extragenital tuberculosis and hormonally depended gynecological diseases are noted. Indications for and efficiency of endosurgical interventions in genital tuberculosis are shown.     

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.     

Primary extensive perianal cutaneous tuberculosis: A challenging diagnosis. Case report and a review of the literature

RationalePerianal tuberculosis is extremely rare without previous or active pulmonary infection. Ulcerative skin lesion is a rare presentation of extrapulmonary tuberculosis in the oral, perianal, or genital mucosa and the adjacent skin.Case reportA 71-year-old woman complained of pain during evacuation and fecal incontinence for two years. There was an ulcerated lesion in the perianal and intergluteal region and perianal fistulous tracts. A polymerase chain reaction test on blood and biopsies of perianal ulcers, perianal fistula, and the intergluteal area was positive for Mycobacterium tuberculosis. The pathological examination revealed a chronic epithelioid granulomatous inflammatory process with the presence of multinucleated giant cells. After the end of the tuberculosis drug regimen, there was marked improvement in the patient's clinical condition.ConclusionEven in the absence of an identifiable primary focus, tuberculosis should be considered in the differential diagnosis of ulcerative and fistulous lesions of the perianal area.     

Pelvic actinomycosis: two cases

INTRODUCTION: Actinomycosis is a chronic suppurative granulomatous disease caused by different Actinomyces species, mostly bacillus: the Actinomyces israeli. The pelvis location of this infection is rare. OBSERVATIONS: We report two cases of actinomycosis that were diagnosed after the surgical treatment of a suspected ovarian tumor and a suspected acute peritonitis. Diagnosis in both cases was based on the histopathologic findings. CONCLUSION: The incidence of pelvic actinomycosis is increasing since 1960 related to the frequent use of intra uterine device. The clinical symptomatology is not specific, simulating a neoplastic or an inflammatory process. The treatment combines operative and antibiotic therapy.     

Actinomycosis of the kidney: a case report

Actinomycosis is a rare infection mainly of the head and neck region (cervicofacial actinomycosis). The cause of this infection is bacterial invasion of the host's mucosal barrier with consecutive infiltration of the surrounding tissues. The treatment of choice after diagnosis is a prolonged course of high-dose antibiotics. The presence of abdominal actinomycosis is at a maximum of 25%, whereas renal involvement appears only sporadically. Aggravating causes for early diagnosis are the appearance of abscesses, fistulae and a debilitating illness resembling carcinoma and leading to surgery as the treatment of choice. Renal actinomycosis is a diagnostic challenge because it is included in the differential diagnosis of renal masses with coexisting B-symptoms. The suspicion requires surgical treatment--nephrectomy. We report on a patient who was transferred to our department for nephrectomy because of radiologically diagnosed renal and perirenal abscesses. The histological result showed renal actinomycosis.