Disseminated Actinomycosis A Rare Cause of Abdominal Pain: A Case Report

Abstract

Abdominal pain is a common clinical presentation that can be caused by a variety of conditions ranging from self-limited to serious pathologies. It may be the first symptom of an occult malignancy, especially in elderly patients or in the presence of systemic manifestations such as weight loss, fever, fatigue, and anorexia. However, functional gastrointestinal disorders, vascular pathologies, renal diseases, genitourinary illnesses, and chronic infections should also be considered as possible causes of abdominal pain. We report a case of a 59-year-old female who presented to our center with a three-month history of abdominal pain and weight loss. Initial workup revealed the presence of a suspicious hepatic mass, circumferential wall thickening of the transverse colon, and pericardial effusion. Exploratory laparotomy with a surgical biopsy of the hepatic mass was performed, and the histopathologic picture was consistent with actinomycosis. The patient was treated successfully despite the initial diagnostic challenges and complicated hospital course.

Keywords: Abdominal Pain; Actinomycosis; Liver.

Figure 1

Contrast-enhanced CT scan of the abdomen in the late arterial phase shows heterogeneously enhancing lobulated lesion in the right hepatic lobe (red arrows).

Figure 2

Contrast-enhanced CT scan of the chest shows a large encysted right pleural effusion 
(white arrows) and moderate pericardial effusion (red arrows).

Figure 3

(a) An Actinomyce surrounded by extensive neutrophils, macrophages, lymphocytes, and plasma cells (hematoxylin and eosin stain, magnification = 20 ×). (b) Periodic acid-Schiff stain (magnification = 20 ×).

Figure 4

(a) Chest X-ray with a large right pleural effusion. (b) Complete resolution.