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. 2015 Jan 7;22(1):19-23.
doi: 10.1016/j.jpge.2014.08.002. eCollection 2015 Jan-Feb.

Hepatic Actinomycosis

Filipa Ávila  1 , Vera Santos  2 , Paulo Massinha  2 , José Renato Pereira  2 , Rui Quintanilha  3 , António Figueiredo  4 , António Lázaro  4 , Sofia Carrelho  5 , João Santos Coelho  5 , Eduardo Barroso  5 , Maria Antónia Duarte  1
Affiliations

Hepatic Actinomycosis

Filipa Ávila et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Actinomycosis is a rare disorder caused by an anaerobic gram-positive bacillus (Actinomyces), predominantly by the Actinomyces israelii species. Only 20% of cases show an abdominal manifestation, the appendix and ileocecal valve being the most frequent locations. Definitive diagnosis is based on microbiological cultures, microscopy or macroscopy examination. Nevertheless, histological examination of the percutaneous biopsy and blood microbiological cultures are rarely positives. Preoperative diagnosis is hampered by the lack of specific clinical and imaging manifestations, which often mimic malignancy. The rate of preoperative diagnosis is less than 10%, however, the outcome is excellent, with a low mortality rate. The authors describe the case of a patient who was diagnosed with primary hepatic actinomycosis only by a histological examination of the surgical specimen of left hepatectomy extended to segments V and VIII, for suspected malignant lesion. This case demonstrates the difficulties in diagnosing hepatic actinomycosis.

A actinomicose é uma entidade clínica rara, causada por uma bactéria anaeróbia gram-positiva (Actinomyces), predominantemente da espécie Actinomyces israelii. Apenas em 20% dos casos apresenta manifestação abdominal, sendo o apêndice e a válvula ileocecal as localizações mais frequentes. Os autores descrevem o caso de um doente em que foi feito o diagnóstico de actinomicose hepática primária apenas pelo exame histológico da peça cirúrgica de hepatectomia esquerda alargada aos segmentos V e VIII, por suspeita de lesão maligna. Este caso demonstra a dificuldade diagnóstica da actinomicose hepática. O diagnóstico pré-operatório é dificultado pela falta de manifestações clínicas e imagiológicas específicas, muitas vezes simulando doença maligna. Para além disso, as culturas e o exame histológico de biópsia percutânea raramente são positivos. A taxa de diagnóstico pré-operatório é inferior a 10%, contudo o prognóstico é bom, apresentando uma taxa de mortalidade de cerca de 7,6%.

Keywords: Actinomyces; Actinomycosis; Granulomatous Disease; Liver Diseases.

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Figures

Figure 1
Figure 1
Abdominal ultrasound: pseudonodular lesion, hypoechoic, heterogeneous and partially undefined in segment IV of the liver.
Figure 2
Figure 2
Contrast-enhanced computed tomography scan: low enhanced lesion in the arterial phase (A), with progressive enhanced in the late phase (B).
Figure 3
Figure 3
MRI: nodular lesion with lobulated and undefined limits, hypointense signal on T1 (A) and hyperintense signal on T2 (B).
Figure 4
Figure 4
Histology of liver fragment: inflammatory pseudotumor (hematoxylin and eosin 100×).
Figure 5
Figure 5
Histological examination allowed the observation of abcesses in several areas. A central zone with neutrophil granulocytes and necrotic tissue is surrounded by a band of fibrous connective tissue that constitutes the abscess capsule, showing the plugs of Actinomyces (A – hematoxylin and eosin, magnification 5×). At higher magnification, filamentous structures corresponding to aggregates of Actinomyces were identified (B and C – PAS 5× and 40× magnification respectively).
See this image and copyright information in PMC

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