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Case Reports
. 2022 Jun 4;22(1):518.
doi: 10.1186/s12879-022-07491-3.

A case of recurrent acute cholecystitis caused by Actinomyces odontolyticus, rare actinomycosis

Kento Furuya  1 , Kenta Ito  2 , Kyohei Sugiyama  3 , Akitsugu Fujita  4 , Hideyuki Kanemoto  4 , Toshio Shimada  2
Affiliations
Case Reports

A case of recurrent acute cholecystitis caused by Actinomyces odontolyticus, rare actinomycosis

Kento Furuya et al. BMC Infect Dis. .

Abstract

Backgrounds: Actinomyces species are gram-positive, obligate anaerobic rods and are rare causes of cholecystitis. Because Actinomyces species are anaerobic bacteria, it is difficult for Actinomyces to survive in bile apart from A. naeslundii. We experienced a case of recurrent acute cholecystitis caused by A. odontolyticus.

Case presentation: A patient had been diagnosed with acute cholecystitis and treated one month before and after that, admitted to our hospital because of recurrent cholecystitis. Gram stain of the bile revealed gram-positive rods and gram-positive cocci. We found A. odontolyticus and MRSA in bile culture and MRSA in blood culture. We administered piperacillin-tazobactam and then changed it to ampicillin-sulbactam and vancomycin. The patient underwent laparoscopic cholecystectomy and was discharged safely.

Conclusions: To our knowledge, this is the first case of cholecystitis caused by A. odontolyticus. Cholecystitis caused by Actinomyces species is rare. In addition, we may overlook it with the low positivity of bile cultures of Actinomyces. Whenever the cholecystitis recurs without any obstruction of the biliary tract, we should search for the gram-positive rods hidden in the bile, such as A. odontolyticus, as the causative organism, even if the bile culture is negative.

Keywords: Actinomyces odontolyticus; Ampicillin/sulbactam; Cholecystitis; Gram stain.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced abdominal CT demonstrated enlarged and multifocal gallbladder and abscesses around the gallbladder, some perforating into the right lobe of the liver and forming liver abscesses
Fig. 2
Fig. 2
Gram stain of bile revealed gram-positive rods without an elongated radial pattern (red arrow) and gram-positive cocci (black arrow). Later, we identified gram-positive rods as A. odontoliticus and gram-positive cocci as MRSA (magnification × 1000, 300 dpi) (This image was acquired and captured using an Olympus BX51 microscope (Olympus, Japan) and Olympus DP20-5 (Olympus, Japan))
See this image and copyright information in PMC

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