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Baba H, Fassi Fihri J, Ramraoui ME, Elguazzar A, Zeroual A, Lahkim M, El Khader A, Achour A, El Barni R. When a rare simultaneous infection simulates a local extension of a rectal cancer: a case report. J Med Case Rep 2021; 15:401. [PMID: 34380562 PMCID: PMC8359103 DOI: 10.1186/s13256-021-02989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Actinomycosis is a rare chronic infection caused by Actinomyces. The abdominopelvic localization of this pathology makes preoperative diagnosis extremely exceptional. The following report is the case of a patient treated for adenocarcinoma of the middle rectum associated with mesorectal actinomycosis. The diagnosis of actinomycosis was made postoperatively. Case presentation A 69-year-old Caucasian male patient was admitted for rectal bleeding. Clinical and paraclinical assessment revealed a middle rectum adenocarcinoma with local extension in the mesorectum. The patient underwent an anterior resection of the rectum by laparotomy after neoadjuvant chemoradiotherapy. Postoperative follow-up was simple. Pathological study of the specimen noted complete sterilization of the rectal adenocarcinoma and the presence of large foci of suppurative necrosis containing actinomycotic grains in the mesorectum. Conclusion Abdominopelvic actinomycosis is a rare pathology and has therefore rarely been dealt with. This issue can lead to unnecessary and mutilating surgery. We report an exceptional coincidence of rectal adenocarcinoma and mesorectal actinomycosis mistaken for mesorectal extension of the cancer.
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Affiliation(s)
- Hicham Baba
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco. .,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco.
| | - Jawad Fassi Fihri
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohammed Essaid Ramraoui
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed Elguazzar
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed Zeroual
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohammed Lahkim
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Ahmed El Khader
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Abdessamad Achour
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
| | - Rachid El Barni
- Department of General Surgery, Avicenna Military Hospital, Marrakesh, Morocco.,Faculty of Medecine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco
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Xu YY, Zhang J, Lu AL, Peng J, Xu XW. Clinical features of actinomycosis: A 20-year experience of a single institute in Southern China. J Mycol Med 2021; 31:101169. [PMID: 34224940 DOI: 10.1016/j.mycmed.2021.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/11/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Actinomycosis is a rare indolent infectious disease with nonspecific clinical presentations that delay diagnosis. Although actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scarce. This study aimed to profile actinomycosis in developing countries and identify how it differed from profiles of developed countries. METHODS Patients fulfilling the inclusion criteria for actinomycosis from Nanfang Hospital in southern China between January 1999 and December 2018 were retrospectively analyzed. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance. RESULTS Thirty‑one patients were included in this study. The disease was diagnosed predominately in the orocervicofacial (n = 14), cardiothoracic (n = 11), abdominopelvic (n = 5), and soft tissue (n = 1) regions. Diagnosis was obtained by either histopathology (n = 29, 94%) or microbiology (n = 2, 6%). Only one-third of patients presented with general symptoms, such as fever and weight loss. Ten were lost during follow-up, and the median duration of antibiotic use was 93.5 days (interquartile range 28-300), whereas the median follow-up time was 34 months (interquartile range 9-132). Ten patients receiving complete resection of the lesion were cured without postoperative use of antibiotics. Only one patient relapsed during the follow-up period. CONCLUSIONS Actinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. Diagnosis was often delayed and was obtained postoperatively from histopathology in developing countries. Hence, clinicians should be aware of this disease in patients with high risk factors. In the future, specific molecular methods may help to improve early diagnosis and treatment.
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Affiliation(s)
- Yu-Yuan Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jian Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ai-Li Lu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xu-Wen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Carrara J, Hervy B, Dabi Y, Illac C, Haddad B, Skalli D, Miailhe G, Vidal F, Touboul C, Vaysse C. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. J Clin Med 2020; 9:jcm9030821. [PMID: 32197366 PMCID: PMC7141382 DOI: 10.3390/jcm9030821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/02/2022] Open
Abstract
The particularity of pelvic actinomycosis lies in the difficulty of establishing the diagnosis prior to treatment. The objective of this retrospective bicentric study was to evaluate the pertinence and efficacy of the different diagnostic tools used pre- and post-treatment in a cohort of patients with pelvic actinomycosis. The following data were collected: clinical, paraclinical, type of treatment, and the outcome and pertinence of the two diagnostic methods, bacteriological or histopathological, were evaluated. Twenty-seven women were included, with a pre-treatment diagnosis proposed for 66.7% (n = 18) of them. The diagnosis was established in 13.6% (n = 3) of cases through bacteriological samples, and in 93.8% (n = 15) of cases through histopathological samples, with endometrial biopsy positive in 100% of cases. The treatment was surgical with antibiotics for 55.6% (n = 15) of patients, medical with antibiotic therapy for 40.7% (n = 11) of patients, and surgical without antibiotics for one patient. All patients achieved recovery without recurrence, with a median follow-up of 96 days (4–4339 days). Our study suggested an excellent performance of histopathological analysis, and in particular endometrial biopsy, in the diagnosis of pelvic actinomycosis. This tool allowed early diagnosis and, in some cases, the use of antibiotic therapy alone, making it possible to avoid surgery.
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Affiliation(s)
- Julie Carrara
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Blandine Hervy
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
| | - Yohann Dabi
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Claire Illac
- Service d’Anatomie-Pathologie, Université de Toulouse, CHU de Toulouse, 31059 Toulouse, France;
| | - Bassam Haddad
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Dounia Skalli
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Gregoire Miailhe
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Fabien Vidal
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
| | - Cyril Touboul
- Service de Gynécologie Obstétrique, Université Paris Est, Paris XII, Hôpital Intercommunal de Créteil, 94000 Créteil, France; (J.C.); (Y.D.); (B.H.); (D.S.); (G.M.); (C.T.)
| | - Charlotte Vaysse
- Service de Chirurgie générale et gynécologique, Université de Toulouse, CHU de Toulouse, UPS, 31059 Toulouse, France; (B.H.); (F.V.)
- Correspondence: ; Tel.: +33-5-6132-2828; Fax: +33-5-3115-5318
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[Pelvic actinomycosis: Diagnostic and therapeutic aspects]. ACTA ACUST UNITED AC 2016; 44:168-74. [PMID: 26857044 DOI: 10.1016/j.gyobfe.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 11/26/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Actinomycosis is a rare little known granulomatous suppurative disease, more common in women, aided by the use of contraceptive purposes intrauterine device (IUD). Pelvic location is the rarest with an extension to adjacent organs making preoperative diagnosis difficult and misleading clinical presentation. Early diagnosis of this affection determines the therapeutic strategy and avoids mutilating interventions especially in young women. METHODS We reviewed the record of women who consulted the department of obstetrics and gynecology at Ben Arous hospital (Tunisia) between January 2003 and December 2013 for a pelvic pain syndrome and in whom diagnosis of actinomycosis was suspected by clinical and imaging and confirmed by pathology. RESULTS Eight cases of gynecologic abdominopelvic actinomycosis were diagnosed during the study period. Seven patients were carriers of an intrauterine device, with an average duration of 5 years wearing. Functional signs were essentially pelvic pain and fever. Physical examination of patients mainly showed two clinical presentations: a pelvic tumor syndrome or abdominopelvic and an array of pelvic abscess or pelvic inflammatory disease. Radiological investigations were allowed to suspect the diagnosis of actinomycosis only in one patient, in whom percutaneous biopsy confirmed the histological diagnosis without resorting to a surgical procedure. Operative procedures performed were varied as appropriate. The diagnosis of actinomycosis was made by pathology without any cases of bacterial isolation. All patients received antibiotic treatment with penicillin. The subsequent evolution was favorable. CONCLUSION The diagnosis of actinomycosis should be considered in any invasive abdominal mass of neoplastic appearance and in case of table of genital infection especially in patients bearing IUD for 5 years or more.
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Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future Microbiol 2016; 10:613-28. [PMID: 25865197 DOI: 10.2217/fmb.14.130] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and 'sulfur granules' are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1-4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical University of Sofia, Bulgaria
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Pulmonary actinomycosis as a rare cause of inflammatory myofibroblastic tumor: a case report. Open Med (Wars) 2013. [DOI: 10.2478/s11536-013-0208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractPulmonary inflammatory myofibroblastic tumor encompasses a heterogeneous spectrum of reactive, infectious, and neoplastic entities. It is composed of spindle-shaped myofibroblastic cells in a background of inflammatory cells and collagen fibres. Actinomycosis is a bacterial infection. It infects the lower respiratory tracts by inhalation or aspiration of oropharyngeal or upper gastrointestinal materials. Only eight cases of pulmonary IMT associated with actinomycosis have been reported in the literature so far. This is the ninth case reported.
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