Hepatic actinomycosis: a very rare form of actinomycosis

A 72-year-old man presented to the emergency department with a history of fever, general malaise, anorexia, and weight loss of 5-6 kilos over the last 3-4 months. He was diagnosed with diabetes mellitus before 7 years. He had no history of abdominal surgery or gastrointestinal intervention. On physical examination, his body temperature was 39.5°C and his abdomen was soft and non-tender. Abdominal ultrasonography revealed a heterogeneous hypoechoic lesion area measuring 90 × 50 mm in the right lobe of the liver. Abdominal computed tomography showed an irregular limited lesion (Figure 1). The patient had fever (39°C-40°C) 2-3 times a day with severe chills, after which cultures were performed and empiric ceftriaxone 2 g/day (IV) was initiated.

The hepatic abscess was evacuated (Figure 2). Cytopathological examination revealed neutrophils, histiocytes, and Actinomyces colonies. The patient was treated with intravenous penicillin G for 45 days and was discharged on treatment with oral ampicillin. The follow-up abdominal magnetic resonance imaging after 2 months revealed no abnormalities (Figure 3). The treatment was completed in 6 months.

FIGURE 1:
Abdominal computed tomography: an irregular limited lesion area with a contoured lobule measuring 110 × 60 mm in the right lobe of the liver (arrows).

FIGURE 2:
The abscess material.

FIGURE 3:
Abdominal magnetic resonance imaging revealed no abnormal findings in the liver.

Actinomyces are anaerobic or microaerophilic gram-positive filamentous bacteria that normally colonize the mouth, colon, and vagina^1,2. Hepatic involvement is present in 5% cases of actinomycosis. While hepatic involvement may be seen in disseminated actinomycosis, isolated involvement is most likely due to a hematogenous spread from an unknown focus.

In the differential diagnosis of liver abscesses, isolated liver actinomycosis should also be considered in patients without a history of abdominal surgery.

References

• ¹
  Russo TA. Agent of Actinomycosis. In: Mandell GL, Bennett JE, Dolin R editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8 th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015 V:2, p. 2864-73.
• ²
  Kim SB, Kim JW, Choi JH. A Rare Cause of Multiple Hepatic Masses. Gastroenterology. 2019;157(3):e12-e13.

Publication Dates

• Publication in this collection
  08 Mar 2021
• Date of issue
  2021

History

• Received
  03 June 2020
• Accepted
  18 Aug 2020