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Primary parotid actinomycosis is extremely rare. Two patients are discussed in whom this disease presented quite differently. The literature is reviewed and the management described, with particular reference to antibiotic therapy.
A case of actinomycosis arising within the masseter following extraction of a lower second molar is reported. The most likely cause was a needle tract infection from the planned administration of the local anaesthetic.
We report an unusual presentation of orofacial actinomycosis mimicking the clinical appearance of a minor salivary gland tumour of the upper lip. Histological examination confirmed the diagnosis and we think that the lesion was caused by infection of a mucocele of the upper lip by Actinomyces israelii, an oral commensal.
A case of bronchial carcinoma following pulmonary and thoracic wall actinomycosis is presented. Although pulmonary defense mechanisms are known to decrease with actimyces infection, the development of malignancy following chronic inflammation as in our case, has not in our knowledge been previously reported.
We report a case of pathologically proved actinomycosis that presented unusual computed tomographic (CT) features: a soft-tissue retroperitoneal mass encasing the adjacent ureter resulting in hydronephrosis and spreading into the intraperitoneal space with a stellate pattern. The role of CT in monitoring the response to antibiotic treatment is also discussed.
We report a case of intrauterine contraceptive device (IUD) associated pelvic actinomycosis due to Actinomyces urogenitalis in a previously healthy young adult woman. Diagnosis was confirmed by 16S ribosomal RNA gene sequencing of bacterial colonies growing from the extracted device. This is the first documented report of human infection caused by this micro-organism.
Pelvic actinomycosis is an infection due to actinomyces organism associated with an intra-uterine contraceptive device. This infection is often revealed by an uni- or bilateral adrenal lesion. Lesions are sometimes more extensive and affect next pelvic organs: rectum, ureter, bladder. Diagnosis is often histologic with percutaneous biopsy or surgical biopsy (laparotomy or coelio surgery). Treatment is mainly medical with prolonged use of penicillin (6 months in severely cases). Surgery must be thrifty and conservative.
We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.
We report a case of successfully managed invasive, thoracoabdominal actinomycosis caused by the intraperitoneal spillage of gallstones during laparoscopic cholecystectomy. The infected gallstones traversed the diaphragm, migrated into the lung parenchyma, and obstructed a segmental bronchus, causing pneumonia. Treatment involved retrieval of the obstructing stone, debridement and drainage of the pleuroperitoneal phlegmon/abscess, and intravenous antibiotics. The case illustrates the need to remove gallstones at the time of cholecystectomy.
Actinomycosis is an unusual intra-abdominal infection, often mistaken for other conditions. We report a case associated with bilateral ureteric obstruction in which a recto-sigmoid stricture developed in previously normal bowel, followed by its complete resolution after treatment with antibiotics, as demonstrated by serial barium enema examinations.
Abdominal actinomycosis is a rare condition which is difficult to diagnose because of its close resemblance to other, more common conditions. The clinical and radiological features of three cases are described and illustrated. The diagnosis is suggested by the rapid development of a fixed mass with fistulae.
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.
Inflammatory pseudotumors present clinically as mass lesions and microscopically show a spectrum of nonspecific inflammatory and regenerative changes. When the mesentery or retroperitoneum are involved, differentiation from inflammatory fibrosarcoma poses a diagnostic problem. The authors report on a 7-year-old boy who presented with fever, anemia, weight loss, and a retroperitoneal mass. Needle biopsy results of the mass showed features consistent with inflammatory pseudotumor. Examination of the resected mass showed actinomycosis.
We report a case of actinomycosis associated with a penile pilonidal sinus. This association does not appear to have been described previously. We recommend the submission of biopsies of unusual lumps in the genital region (fresh biopsies for bacteriological examination and fixed biopsies for histomorphological assessment).
Actinomycosis of the testicle is a rare clinical entity. A review of the literature reveals only 7 case reports. Patients require prolonged therapy with antibiotics, usually penicillin. Many patients with less severe forms of the disease improve on antibiotics alone. Surgical intervention is reserved for confirming the diagnosis, treatment of abscesses, excision of sinus tracts and drainage. We report case 8 in the literature and review the previous reports.
A 25-year-old Haitian man presented with a post-traumatic left retroperitoneal abscess. Culture of material obtained during surgical drainage yielded Actinomyces israelii. Retroperitoneal actinomycosis is a particularly unusual manifestation of infection with this organism. Because it may mimic subacute infections or malignant masses in terms of clinical findings, diagnosis of this entity may be difficult. Our diagnosis was based on the results of culture, and the patient responded to long-term penicillin therapy.
We report a case of actinomycosis of the prostate with symptoms of acute prostatitis. Laparotomy was required to establish an etiological diagnosis. Long-term therapy with erythromycin resulted in a clinical cure.
We present a case of ureteral obstruction secondary to pelvic actinomycosis. Despite stenting, prolonged antibiotic therapy, and debridement, the patient required ureteral resection and reconstruction. This condition may simulate advanced malignancy, and diagnostic suspicion lessens the need for radical extirpative surgery.