1
|
Lesmana A, Wirdhani V, Perangin Angin LBR, Muzakky MI, Hayon SGV, Sholihah MM, Hanif MI. Sigmoid colon pseudotumor of actinomycosis: a rare case. J Surg Case Rep 2024; 2024:rjad697. [PMID: 38186751 PMCID: PMC10766591 DOI: 10.1093/jscr/rjad697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Actinomycosis is a chronic suppurative infection caused by gram-positive bacteria, Actinomyces, which commonly colonize the oral cavity, urogenital tract and gastrointestinal tract. It causes opportunistic infection where the mucosal barrier is compromised and is often misdiagnosed as malignancy. We report a case of a 58-year-old female with severe abdominal pain and a palpable tender mass in the left lower quadrant. Computed tomography scan with contrast showed thickening of the transverse, descending to sigmoid colon wall and intense contrast enhancement resembling colitis with mesenteritis. At laparotomy, we found an adherent mass involving sigmoid colon with adjacent small bowel and peritoneum. We decided to perform adhesiolysis and Hartmann procedure. The culture result was negative, whereas the biopsy of sigmoid colon revealed characteristic sulfur granules of actinomycosis colony. Intravenous antibiotic combination of ceftazidime and metronidazole was administered for 14 days followed by complete resolution of symptoms. Histopathological and bacteriological examinations are keys to diagnose actinomycosis. Patients require long-term antibiotic therapy, but surgery is often required because preoperative diagnosis is difficult. Main novel aspects? We presented the rare case of intra-abdominal actinomycosis in IndonesiaThe case was challenging to diagnose pre-operatively based on physical examination andExploratory laparotomy revealed pseudotumor mimicking advanced stage of colon neoplasm.
Collapse
Affiliation(s)
- Andy Lesmana
- Surgery Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Vika Wirdhani
- Internal Medicine Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | | | - Muhamad I Muzakky
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Stefi G V Hayon
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Mentari M Sholihah
- Emergency Department, Dr. Sitanala Central Hospital, Tangerang, Indonesia
| | - Muhammad I Hanif
- Emergency Department, Badau Primary Health Care, Kapuas Hulu, Indonesia
| |
Collapse
|
2
|
Ioannidis O, Symeonidis S, Ouzounidis N, Foutsitzis V, Anestiadou E, Christidis P, Loutzidou L, Fesatidou V, Kerasidou O, Tsalis K, Aggelopoulos S. Two case reports of mesenteric and retroperitoneal actinomycosis and a narrative review of the relevant literature. Med Pharm Rep 2023; 96:441-446. [PMID: 37970198 PMCID: PMC10642741 DOI: 10.15386/mpr-2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/13/2022] [Accepted: 01/22/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Actinomycosis is an uncommon subacute or chronic suppurative bacterial granulomatous infectious disease with clinical heterogeneity. The majority of actinomycosis cases were of extra-abdominal origin, with oro-cervico-facial cases representing 55%, abdominopelvic representing 20%, and thoracic representing 15% of total reports. Currently, abdominal actinomycosis incidence is approximately 1 case per 119,000 people, being found three times more frequently among males. We report two rare clinical presentations of abdominal actinomycosis affecting the mesentery and the retroperitoneum, respectively. Case Report 1 A 58-year-old Caucasian male presented to our clinic with abdominal pain in the right upper quadrant. Pre-operative evaluation, although inconclusive, showed a mesocolic mass infiltrating the right and transverse colon. The patient underwent exploratory laparotomy. After partial resection of the mass, the histopathology report demonstrated mesenteric actinomycosis. Case Report 2 A 40-year-old Caucasian male presented to our clinic complaining about a mucopurulent material from an orifice at the right inguinal region. After appropriate work-up, a large abdominopelvic, stellate mass (75 x 22.8 mm) in the retroperitoneum was revealed. Surgery along with the appropriate antibiotics was used to treat the patient. Conclusion Preoperative suspicion and diagnosis of actinomycosis are very challenging, with a high rate of misdiagnosis often resulting in delayed treatment. Our case reports highlight that abdominal actinomycosis should always be part of differential diagnosis, especially when there is involvement of multiple organs. The gold standard treatment of actinomycosis is surgical excision with prolonged antibiotic treatment.
Collapse
Affiliation(s)
- Orestis Ioannidis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Savvas Symeonidis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Ouzounidis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasilis Foutsitzis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Elissavet Anestiadou
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Panagiotis Christidis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Lydia Loutzidou
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasiliki Fesatidou
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Ourania Kerasidou
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Konstantinos Tsalis
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
3
|
Lyew MA, Morris C, Smith K, Stennett M. Case report: Colonic actinomycosis - A rare cause of a locally advanced colonic tumour. Int J Surg Case Rep 2023; 105:107957. [PMID: 36907045 PMCID: PMC10025125 DOI: 10.1016/j.ijscr.2023.107957] [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: 11/13/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Colon cancer is a common malignancy and is often encountered initially as locally advanced disease. However, there are many benign clinical entities that may masquerade as complicated colonic malignancy. Abdominal actinomycosis is one such rare mimic. CASE PRESENTATION A 48-year-old female presented with a progressively enlarging abdominal mass with skin involvement and clinical features of partial large bowel obstruction. Computed tomography (CT) revealed a mid-transverse colonic lesion at the centre of an inflammatory phlegmon. At laparotomy, the mass was found to be adherent to the anterior abdominal wall, gastrocolic omentum, and loops of jejunum. En block resection was performed with primary anastomosis. Final histology showed no evidence of malignancy, but mural abscesses containing pathognomonic sulphur granules and actinomyces species. CLINICAL DISCUSSION Abdominal actinomycosis, particularly of the colon, is rare and exceptionally so in immunocompetent patients. However, the clinical and radiographic presentation often mimics more common conditions such as colon cancer. Accordingly, surgical resection is typically radical to clear margins, and diagnosis is made only on final histopathology. CONCLUSION Colonic actinomycosis is an uncommon infection but the diagnosis should be considered particularly in colonic masses with anterior abdominal wall involvement. Oncologic resection remains the mainstay of treatment and the diagnosis commonly made retrospectively given the rarity of the condition.
Collapse
Affiliation(s)
- Matthew-Anthony Lyew
- Department of General Surgery, Kingston Public Hospital, Kingston, Jamaica; Department of Surgery, Radiology, Anaesthesia and Intensive Care, University Hospital of the West Indies, Mona, Jamaica.
| | - Conrad Morris
- Department of General Surgery, Kingston Public Hospital, Kingston, Jamaica
| | - Kevan Smith
- Department of General Surgery, Kingston Public Hospital, Kingston, Jamaica
| | - Memory Stennett
- Department of Pathology, National Public Health Laboratory, Kingston, Jamaica
| |
Collapse
|
4
|
Badiani S, Chen MZ, Kevric J, Strugnell N. Rare case of acute large bowel obstruction secondary to pelvic actinomycosis. ANZ J Surg 2022; 93:1052-1053. [PMID: 36208019 DOI: 10.1111/ans.18094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sarit Badiani
- Department of Colorectal Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Michelle Zhiyun Chen
- Department of Colorectal Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Jasmina Kevric
- Department of Colorectal Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Department of Colorectal Surgery, The Northern Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Al-nasseri A, Hammad W, Younes I, Sachdeva N, Elkattawy S, Omran A, Mowafy A, Fish H. Colonic Actinomycosis Presenting One Year After Partial Sigmoid Colectomy. Cureus 2022; 14:e23954. [PMID: 35547437 PMCID: PMC9085653 DOI: 10.7759/cureus.23954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/05/2022] Open
|
6
|
Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease. Life (Basel) 2022; 12:life12030447. [PMID: 35330198 PMCID: PMC8954618 DOI: 10.3390/life12030447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.
Collapse
|
7
|
Kaplan K, Sarıcı KB, Usta S, Özdemir F, Işık B, Yılmaz S. Primary Hepatic Actinomycosis Mimicking Neuroendocrine Tumor. J Gastrointest Cancer 2022; 54:294-296. [PMID: 35184235 DOI: 10.1007/s12029-022-00806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Actinomyces species is a fastidious, gram-positive, non-spore-forming bacteria that thrive in microareophilic and anaerobic conditions. Infection in the liver, an organ rarely affected by this pathogen, is presumed to be caused by hematogenous spread through the portal vein from a mucosal injury or other abdominal injury or a focus of infection. CASE DESCRIPTION A 60-year-old male patient has a mass lesion of 15 × 10 cm in the left lobe on computed tomography. A tru-cut biopsy was performed with USG, and fragmented tissue pieces were obtained. In histopathological examination, these samples were reported as tumors with neuroendocrine differentiation. The biopsy sample contains a large amount of tumor neighborhood, and tumoral area is quite small. And, therefore, a clear diagnosis could not be found. A mass lesion with mildly increased Ga 68 DOTATATE uptake was observed in the left lobe of the liver (SUVmax value 3.8) and was interpreted in favor of the primary neuroendocrine tumor of the liver. DISCUSSION Actinomyces cases are very rare and their diagnosis is usually delayed due to its slow and insidious course, and lack of specific clinical and radiological findings. It is difficult to make a correct diagnosis even in microbiological examinations and biopsy materials obtained in the presence of imaging methods. It can mimic tumors of abdominopelvic structures. CONCLUSION Actinomyces should be kept in mind in cases with liver masses accompanied by previous abdominal surgery, abdominal trauma, high fever, and leukocytosis.
Collapse
Affiliation(s)
- Kuntay Kaplan
- Department of General Surgery, Inonu University, Malatya, Turkey.
| | | | - Sertaç Usta
- Department of General Surgery, Inonu University, Malatya, Turkey
| | - Fatih Özdemir
- Department of General Surgery, Inonu University, Malatya, Turkey
| | - Burak Işık
- Department of General Surgery, Inonu University, Malatya, Turkey
| | - Sezai Yılmaz
- Department of General Surgery, Inonu University, Malatya, Turkey
| |
Collapse
|
8
|
Floyd R, Hunter S, Abu Saadeh F, McDonnell C, McCormick P. Pelvic actinomycosis. QJM 2021; 114:587-588. [PMID: 33682880 PMCID: PMC8570843 DOI: 10.1093/qjmed/hcab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/26/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- R Floyd
- Department of Colorectal Surgery, St. James’s Hospital, Dublin 8, Ireland
- Department of Gynaecology, Gynaecological Cancer Care Centre, St. James’s Hospital, Dublin 8, Ireland
- Address correspondence to Dr R. Floyd, Department of Gynaecology, Gynaecological Cancer Care Centre, St. James’s Hospital, Dublin 8, Ireland.
| | - S Hunter
- Department of Gynaecology, Gynaecological Cancer Care Centre, St. James’s Hospital, Dublin 8, Ireland
| | - F Abu Saadeh
- Department of Gynaecology, Gynaecological Cancer Care Centre, St. James’s Hospital, Dublin 8, Ireland
| | - C McDonnell
- Department of Radiology, St. James’s Hospital, Dublin 8, Ireland
| | - P McCormick
- Department of Colorectal Surgery, St. James’s Hospital, Dublin 8, Ireland
| |
Collapse
|
9
|
Charernsuk M, Tunruttanakul S, Tunruttanakul R, Chareonsil B. Colonic actinomycosis presenting as a palpable colonic mass with normal colonic mucosa. J Surg Case Rep 2021; 2021:rjab381. [PMID: 34512947 PMCID: PMC8427729 DOI: 10.1093/jscr/rjab381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/08/2021] [Indexed: 11/23/2022] Open
Abstract
Colonic actinomycosis is rare and can present as an ill-defined intra-abdominal mass that can be difficult to differentiate from colon cancer. This case report aims to share the details of this case and provide diagnostic clues. A 63-year-old female presented with a palpable right-sided abdominal mass. Computed tomography (CT) revealed irregular thickening of the colonic hepatic flexure, and colonoscopy detected no abnormalities. Five months later, the patient returned with an increase in the mass size. Repeat CT revealed lesion expansion, with suspected abdominal wall invasion. Extended right-hemicolectomy with abdominal wall wedge resection was performed, and the histological results were compatible with actinomycosis infection. Colonic actinomycosis is a rare chronic inflammatory disease. Normal colonic mucosa during colonoscopy, with clinical and imaging findings, may help physicians diagnose the condition preoperatively.
Collapse
Affiliation(s)
- Mai Charernsuk
- Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | | | | | | |
Collapse
|
10
|
Jabi R, Ramdani H, Elmir S, Elmejjati F, Serji B, El Harroudi T, Bouziane M. Pseudotumoral Actinomycosis Mimicking Malignant Colic Disease: A Case Report and Literature Review. Visc Med 2020; 36:333-337. [PMID: 33005660 DOI: 10.1159/000502895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023] Open
Abstract
Abdominal actinomycosis is a rare, chronic, and often unrecognized suppurative disease. It is caused by an anaerobic gram-positive bacterium, most commonly Actinomyces israeli. Colonic actinomycosis is rarely reported and may be responsible for a pseudotumoral syndrome leading, in the suspicion of malignancy, to a large and mutilating excisional surgery. It is usually the histopathological examination of the surgical specimens that accurately corrects the diagnosis. Here, we report a rare case of a colic actinomycotic involvement taking a pseudotumoral form. The diagnosis was made based on the pathological examination of the surgical piece. Intravenous and then adjuvant oral penicillin G treatment has allowed a favorable clinical evolution. This observation illustrates the preoperative diagnostic difficulties of this rare disease.
Collapse
Affiliation(s)
- Rachid Jabi
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Hanae Ramdani
- Radiology Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Siham Elmir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Fouad Elmejjati
- Radiotherapy Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Badr Serji
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Tijani El Harroudi
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| | - Mohammed Bouziane
- General Surgery Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, Morocco
| |
Collapse
|
11
|
Memon RA, Shafquat Y, Yaqoob N. Abdominal actinomycosis in an elderly diabetic. Pak J Med Sci 2019; 36:S98-S100. [PMID: 31933616 PMCID: PMC6943106 DOI: 10.12669/pjms.36.icon-suppl.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Actinomycosis is a rare infectious disease that presents as three entities, cervico-facial, abdominal and genital, with cervico-facial being the commonest. Due to its subacute presentation and indolent course, abdominal actinomycosis is difficult to diagnose and is often confused with malignancy. We present a case of an elderly diabetic with no known other risk factors of the disease with complaints of right sided abdominal swelling and presence of abdominal mass on imaging, diagnosed post operatively as a case of abdominal actinomycosis, on histopathology. Abdominal actinomycosis should be considered in differentials in cases with abdominal masses. Diabetes Mellitus is not an established risk factor for development of abdominal actinomycosis. Studies are required to link its association with the disease.
Collapse
Affiliation(s)
- Riyasat Ahmed Memon
- Riyasat Ahmed Memon, MBBS. Registrar, Section of Histopathology, Department of Pathology, The Indus Hospital, Karachi, Pakistan
| | - Yusra Shafquat
- Yusra Shafquat, MBBS, FCPS. Consultant Microbiologist, Section of Microbiology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan. The Indus Hospital, Karachi, Pakistan
| | - Nausheen Yaqoob
- Nausheen Yaqoob, MBBS, FCPS. Consultant and Head of Section of Histopathology, The Indus Hospital, Karachi, Pakistan
| |
Collapse
|
12
|
Ryu DJ, Jeon YS, Kwon HY, Choi SJ, Roh TH, Kim MK. Actinomycotic osteomyelitis of a long bone in an immunocompetent adult: a case report and literature review. BMC Musculoskelet Disord 2019; 20:185. [PMID: 31043170 PMCID: PMC6495508 DOI: 10.1186/s12891-019-2576-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. CASE PRESENTATION A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. CONCLUSIONS Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.
Collapse
Affiliation(s)
- Dong Jin Ryu
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Yoon Sang Jeon
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Hea Yoon Kwon
- Department of Infectious Disease, College of Medicine, Inha University Hospital, Incheon, South Korea
| | - Suk Jin Choi
- Department of Pathology, College of Medicine, Inha University Hospital, Incheon, South Korea
| | - Tae Hoon Roh
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea
| | - Myung Ku Kim
- Department of Orthopedic Surgery, College of Medicine, Inha University Hospital, 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, South Korea.
| |
Collapse
|
13
|
Zamani F, Sohrabi M. Clinical, endoscopic, and histopathological aspects of sigmoid actinomycosis; a case report and literature review. Middle East J Dig Dis 2015; 7:41-4. [PMID: 25628853 PMCID: PMC4293800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 10/28/2022] Open
Abstract
Actinomycosis is a rare and chronic infectious disease caused by a non-spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon. A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. Her complaints and colonic mass resolved totally. Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection.
Collapse
Affiliation(s)
- Farhad Zamani
- 1. GastoIntestinal and Liver Disease Research Centre(GILDRC), Iran University of Medical Sciences, Tehran, Iran
, Corresponding Author: Farhad Zamani, MD Gasterointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran Telefax: + 98 21 88941831
| | - Masoudreza Sohrabi
- 1. GastoIntestinal and Liver Disease Research Centre(GILDRC), Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Blanco-Vela C, Luna-Ayala V, Perez-Aguirre J. Colonic mass secondary to actinomycosis: A case report and literature review. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
[Colonic mass secondary to actinomycosis: a case report and literature review]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:206-8. [PMID: 24880530 DOI: 10.1016/j.rgmx.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/04/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022]
|
16
|
Petersen S, Würschmidt F, Gaul H, Caselitz J, Schwenk W. Actinomyces infection mimicking tumor-progression in rectal cancer under neoadjuvant therapy. Acta Oncol 2012; 51:270-2. [PMID: 22263972 DOI: 10.3109/0284186x.2011.604346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|