Renal actinomycosis presenting as uro-cutaneous fistula

Abstract

Renal actinomycosis is a rare clinical entity. Diagnosis is usually made after resection. A 36-year-old male presented with uro-cutaneous fistula and left xanthogranulomatous pyelonephritis. He was offered left open radical nephrectomy. Intra-operatively, there was "woody" inflammation of the left kidney fistulizing to the splenic flexure of the colon. We successfully resected it and a segment of the colon that had fistulized. His tissue cultures grew Actinomyces odontolyticus. Post-operatively, he received 6 weeks of intravenous beta-lactam antibiotic. He recovered well without any complications. In conclusion, renal actinomycosis can be challenging to diagnose, operate and eradicate. Perioperative considerations are presented for successful management.

Keywords: Actinomycosis; Disease management; Infection; Kidney calculi; Pyelonephritis xanthogranulomatous; Urinary fistula.

Fig. 1

Contrast-enhanced Computed Tomography images from initial presentation showing an atrophic left kidney with a staghorn stone on coronal image (A) and a urocutaneous fistula (arrow) on axial image (B).

Fig. 2

Gross image of the resected left kidney showing the “woody” appearance.

Fig. 3

A photo-micrograph of renal parenchymal sections stained with Gram stain showing thin filamentous branching gram-positive rods with apparent beading (black arrows). (X1000 Magnification).