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. 2018:45:101-103.
doi: 10.1016/j.ijscr.2018.03.024. Epub 2018 Mar 21.

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report

Naoto Tsujimura  1 , Hiroyoshi Takemoto  2 , Yujiro Nakahara  3 , Masaki Wakasugi  3 , Takashi Matsumoto  3 , Kiyonori Nishioka  3 , Kou Takachi  3 , Satoshi Oshima  3 , Kyotaro Yoshida  4
Affiliations

Intraabdominal actinomycosis resulting in a difficult to diagnose intraperitoneal mass: A case report

Naoto Tsujimura et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces israelii. Preoperative confirmed diagnosis is very difficult, so most cases are diagnosed preoperatively as malignant tumors. We report a case of intraabdominal actinomycosis which was difficult to diagnose preoperatively.

Presentation of the case: A woman, 60 years old, experienced discomfort in her lower right abdomen. She complained of nausea and anorexia and visited our hospital. Laboratory blood tests, abdominal CT, and abdominal MRI led to a diagnosis of a uterine sarcoma or primary intestinal mass, and she underwent surgery. Her histopathological diagnosis was intraabdominal actinomycosis.

Discussion: Actinomycosis is a chronic purulent granulomatous inflammation caused by Actinomyces israelii. No clinical symptoms or laboratory findings are characteristic of abdominal actinomycosis, so this disorder is very difficult to diagnose preoperatively. Therefore, many cases are diagnosed as malignant tumors and undergo surgery. After surgery, long-term antibiotic treatment (penicillin) is usually administered.

Conclusions: We reported a case of intraabdominal actinomycosis that resulted in a difficult to diagnose intraperitoneal mass. When a large intraperitoneal mass is found, actinomycosis needs to be included as one of differential diagnoses.

Keywords: Actinomycosis; Chronic suppurative granulomatous disease; Intraperitoneal mass.

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Figures

Fig. 1
Fig. 1
CT scan showing an extensive mass and the surrounding tissue, accompanied by a contrast effect in the abdominal cavity.
Fig. 2
Fig. 2
The mass was seen with a low signal intensity on T1-weighted images (2A) and with an inhomogeneous signal intensity on T2-weighted images (2B). The boundary between the tumor and the uterus was unclear.
Fig. 3
Fig. 3
Photographs showing the normal intestinal mucosa; no invasion into the ileocecal valve was observed. Cecal wall thickening showing a suspected cecal or appendiceal tumor.
Fig. 4
Fig. 4
The histopathological findings confirmed a bacterial mass in the tissue. A radial corona consisting of a crown structure and a collection of neutrophils was observed around the bacterial mass.
See this image and copyright information in PMC

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