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A case of the rare condition of renal and retroperitoneal actinomycosis is presented. The clinical and imaging (ultrasonography and computed tomography) findings are described and attention is drawn to the diagnostic difficulties in this rare disease.
A 34-year-old woman presented with a left-sided suprarenal space-occupying lesion on sonography. Culture of material obtained during sonographic-guided puncture of the retroperitoneal lesion yielded a mixed flora of Actinomyces and Peptostreptococcus. Initially, a misleading diagnosis of an adrenal pheochromocytoma was initiated by highly positive metaiodobenzylguanidine scintigraphy after chemical chemistry vanillylmandelic acid (VMA) test showed elevated values for adrenaline and its derivatives. Retroperitoneal actinomycosis with yet unproven spread into thoracic and cervical compartments is a particular unusual presentation of an infection with these organisms. Because it may mimic subacute infections or malignant masses in terms of clinical and laboratory findings, radiological diagnosis of this entity may be difficult. The diagnosis was based on results of culture and the response of the patient to long-term penicillin-derivate therapy after surgical drainage of the suprarenal abscess formation.
A case of actinomycotic brain infection in a juvenile patient is described. Cases of actinomycosis affecting the head and neck are rare, particularly in juvenile patients. In this case complete resolution of the infection was achieved by means of surgical treatment and prolonged antibiotic therapy. The authors emphasize the importance of a combined approach for treatment of this unusual brain infection and stress the difficulties involved in the diagnosis of this pathology.
Abdominal actinomycosis (AMC) is a rare infection in children. The appendix is the most common intra-abdominal organ involved. It presents as an undifferentiated mass, forming abscesses and fistulas in the right lower quadrant. The case of a 15-year-old girl with a AMC of the appendix detected by the pathologist after routine appendectomy is discussed. Long-term antibiotic treatment and follow-up by ultrasound and laboratory controls are necessary.
Dropped bile and gallstones after accidental perforation of the biliary gallbladder is a frequent event during laparoscopic cholecystectomy and is generally of no clinical importance. However, calculi left in the abdominal cavity can produce a series of severe late complications. We present a patient with retroperitoneal actinomycosis produced by dropped gallstones after a laparoscopic cholecystectomy.
We report an unusual case of superior vena cava syndrome (SVCS) caused by thoracic actinomycosis in a 35-year-old man. The patient presented with a mediastinal mass and the diagnosis was confirmed by a right exploratory thoracotomy. Treatment with penicillin for a 15-month period resulted in a reduction in the size of the mediastinal mass and improvement of his clinical symptoms.
Several recent reports have indicated the possible association between pelvic infection caused by Actinomyces and the use of intrauterine contraceptive devices. Seven cases of infection or colonization of the female genital tract have been detected among women using intrauterine contraceptive devices (IUD's) at Grady Memorial Hospital, Atlanta, Georgia, from March, 1975, until May, 1977. No single IUD type has been incriminated. The shortest duration of consecutive IUD use before the diagnosis was two and a half years. Six of these cases were detected incidentally at the time of endometrial or endocervical biopsy. The diagnosis in each case was made histologically. One patient presented with severe pelvic inflammatory disease and had Actinomyces identified. This is the first reported death associated with pelvic actinomycosis in a woman using an IUD. This organism must be considered as a possible pathogen whenever a patient with an IUD develops pelvic inflammatory disease.
Cervicofacial actinomycosis is a disease that is currently encountered as a pseudotumor entity or cold abscess. The frequent use of antibiotics in treatment of masses in the cervicofacial region may either delay its appearance or disguise the diagnosis. The surgeon must be highly suspicious when making the diagnosis since precautions in handling the biopsy specimens are necessary. Treatment consists of incision biopsy and drainage or aspiration to establish the diagnosis, followed by prolonged penicillin therapy. In those patients allergic to penicillin, clindamycin should be the initial drug of choice. Either medication must be administered for a prolonged period of time, even after the disease is clinically controlled.
Four cases of female genital actinomycosis are added to the reported total of about 300. The relationship of the disease to the normal microbial flora, intrauterine contraceptive device usage and pelvic sepsis is explored. It is suggested that the disease may be more frequent than hitherto realized.
Two cases of actinomycotic lesions of the periapical tissue in relation to the molars are described. The difficulty in obtaining a positive culture for actinomycetes in spite of definite histologic evidence of actinomycosis is highlighted. Besides antibiotics, the importance of planned treatment to deal with the underlying diseased periapical tissue and the tooth is emphasized.
A patient with periapical actinomycosis of approximately 3 years' duration was treated conservatively with tissue management and antibiotic therapy. Twelve months after therapy, bone regeneration is almost complete and there is no sign of recurrence.
An analysis of actinomycosis in periapical inflammatory lesions in the English-language literature was carried out. Nineteen cases were found, and an additional case is presented. The most frequent locations for these infections were the maxillary central incisor region and the mandibular first molar region. The average age of the patients was 27.5 years, and a slight male predilection was noted. Formation of draining sinuses, local swelling, and pain were the most common presenting symptoms. Many of the cases were diagnosed following endodontic procedures, suggesting that such procedures might be responsible for introducing the organisms into the periapical tissues or that the organisms might be responsible for some cases of endodontic failure.
A case of blastomycosis limited to the oral cavity is presented. The disease apparently originated in the mandible and eroded into the oral cavity. Secondary bacterial infection of the sinus tracts resulted in a clinical picture that mimicked cervicofacial actinomycosis. Appropriate microbiologic studies, including culture confirmation of the causative organism, were necessary to establish a definitive diagnosis.
Actinomycosis is an uncommon chronic disease usually caused by Actinomyces israelii. It affects the soft tissue mainly but sometimes spreads to involve salivary glands, bone, or even the skin of the face and neck. Five cases have been seen in our department. Several imaging modalities were used to assist in making the diagnosis. The cases are presented and the literature reviewed. Ultrasonography was found to be a useful diagnostic tool especially in developing the differential diagnosis.
Renal actinomycosis is an endogenous systemic fungal disease with rare renal involvement. Diagnosis, pathogenesis, and therapy are discussed.
A 14-year-old boy presented with a mass measuring 6 cm x 9 cm, proximal to the patella on the anterior aspect of the knee. Magnetic resonance imaging revealed a 6 x 8 x 4 cm smoothly marginated slightly heterogeneous ellipsoidal mass which displaced musculature, the adjacent cutaneous fat and the quadriceps tendon. At surgery, the mass was noted not to penetrate the superficial surface of the quadriceps tendon and was full of slimy fluid. Histological examination revealed multiple basophilic lobulated granules with homogeneous centres and eosinophilic peripheral clubbed projections. The organisms grown anaerobically were identified as Actinomyces species. The anatomical site of the lesion is very unusual for actinomycosis and the exact route of infection in this patient remains unclear.
We describe a case of actinomycosis with several unusual features. The patient has been under medical supervision for more than 20 years; the disease has spread in an atypical manner and did not respond to standard therapy. Finally, there has been an unexpected response to a prolonged course of a member of the quinolone group of antibiotics.
We present a patient referred for radiotherapy for a presumed pulmonary malignancy, who was found to suffer from an actinomycotic infection. This case illustrates the importance of early consideration of actinomycosis when diagnostic methods are negative for malignancy or specific chestwall and bony lesions are observed.