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Hepatic actinomycosis is an uncommon entity that forms communicating abscesses and fistulae. A case is presented in which findings on ultrasound, CT, and percutaneous injection of the abscess all reflected the pathologic process. Biopsy by thin-needle aspiration under CT guidance afforded prompt, accurate diagnosis and effective therapy.
The diagnosis of abdominal actinomycosis is difficult because of its relative infrequency and imitation of other diseases. We present four cases in which these difficulties in diagnosis were experienced and show the utility of CT in suggesting this disease. Aspiration, biopsy, and proper culture technique, in conjunction with typical CT findings of transfascial and multiple organ involvement, led to the proper diagnosis in all cases.
Death from actinomycosis, although unusual today, was devastating at one time. Although commonplace today, using antibiotics to save patients from death was unusual when penicillin was first introduced over 50 years ago.
Actinomyces and Nocardia species are frequently overlooked pulmonary pathogens until their presence is histologically proved. These infections often are not considered in the differential diagnosis of lung disease because of the spectrum of their presentation, the similarity of their appearance to other granulomatous or neoplastic diseases, and coexistence of these infections with other pulmonary conditions. Pulmonary actinomycosis is characterized by pulmonary consolidation, frequently with cavitation and spread to contiguous tissues without regard for normal anatomic barriers. The appearance often is confused with that of bronchogenic carcinoma or other granulomatous infections, especially tuberculosis. Pulmonary nocardiosis most frequently develops in immunocompromised patients, and the incidence of this infection is increasing. The radiographic manifestations of nocardiosis are pleomorphic, but early recognition is essential to initiate appropriate therapy.
Two 11-year-old boys had similar clinical courses of abdominal actinomycosis complicating ruptured appendicitis and manifesting as abdominal masses causing hydronephrosis. Cure was effected by surgery and prolonged penicillin therapy.
A patient had extensive retroperitoneal actinomycosis with renal and vertebral involvement. Abdominal computed tomography was invaluable in defining the extent of the disease and in assessing the effects of therapy. A cure was accomplished with a prolonged course of oral penicillin and probenecid, and surgical exploration was avoided.
A 44-year-old man had an abscess involving the left psoas muscle and inferior pole of the left kidney associated with characteristic sulfur granules of actinomycosis. The patient was treated with surgical drainage and debridement and with intensive and prolonged penicillin therapy, resulting in a clinical cure and resolution of both the hydronephrosis and the retroperitoneal mass.
BACKGROUND: Actinomycotic pelvic infection usually occurs in the presence of an intrauterine device. It can result in pelvic inflammatory disease, tubo-ovarian abscess, and retroperitoneal fibrosis. CASE: A 35-year-old multipara who had never used an intrauterine device presented with a 5-month history of progressively worsening, colicky, right-sided abdominal pain, dysuria, weight loss, and constipation. She was found to have retroperitoneal fibrosis. The diagnosis of actinomycotic pelvic infection was made at laparotomy. CONCLUSION: Actinomycosis may be considered in the differential diagnosis of women with retroperitoneal fibrosis, even when there is no history of an intrauterine device.
Osteomyelitis attributable to Actinomyces often results in recurrent disease and inconsistent responses to antimicrobial agents. We present data for 4 patients and a review of the 15 previously described pediatric cases of actinomycosis presenting as osteomyelitis. Fourteen cases involved the mandible and 5 cases involved other sites. All mandibular cases required at least 1 debridement, with 4 of the cases requiring multiple debridements.
We are reporting a case of a rare renal actinomycosis in a 12-year-old mentally-retarded girl. Proteinuria and hemopyuria were pointed out one year before the operation by an annual medical check-up and IVP subsequently performed showed foreign bodies at the upper pole of the right kidney. The patient continued to have pyuria and right nephrectomy was performed. There was a fistula between the duodenum and the upper portion of the right kidney. Foreign bodies (two bobby pins) were found in the kidney. Subsequent pathologic examination of the resected kidney revealed an actinomycotic lesion.
Actinomycosis is a rare disease, which is most commonly seen in the cervicofacial region and provides problems in diagnosis and treatment. Cervicofacial actinomycotic osteomyelitis is a curable disease. Its natural history and guides to its management are described.
A rare case of primary actinomycosis of the abdominal wall presenting as a tumour is described. The patient responded to penicillin therapy well. A brief account of the literature is included.
This report describes the sixth case of actinomycosis of the gall bladder and discusses the salient features of the diagnosis and management of this rare disease.
Two cases of primary actinomycosis of the abdominal wall masquerading as abdominal wall tumours are presented. The interesting clinical presentation and the difficulty in diagnosis are discussed.
A patient with acute peritonitis due to ovarian actinomycosis and the association of this disease with the intrauterine contraceptive device is discussed. Because adequate treatment requires prolonged antibiotics the diagnosis should be sure. Unfortunately if antibiotics are given pre-operatively culture is usually unsuccessful and thus careful examination of all removed material is essential. As many of these women are of child bearing age surgical intervention should aim to preserve fertility wherever possible.
A case of pulmonary actinomycosis presenting with a right calf abscess and complicated by effusive constrictive pericarditis is discussed. Clinical improvement occurred with antibiotic therapy and pericardiectomy. There was no evidence of recurrence after 18 months.
A 26 year old woman who had had an intrauterine contraceptive device had an abdominal mass due to actinomycosis excised three months after routine laparoscopy. The aetiology and possible association with laparoscopy is discussed.
A case of actinomycosis following insertion of an intrauterine contraceptive device is reported. The patient was treated successfully by antibiotic therapy and conservative surgery.