Abdominal actinomycosis with multiple myeloma: A case report

Abstract

Actinomycosis is a chronic suppurative infection, for which immune suppression is a predisposing factor. In unusual cases, this disease may present as an abdominal wall involvement simulating a soft tissue tumor as seen in the present case. The presented patient had no signs of trauma or surgical approach and the pathology was considered to be a primary abdominal wall actinomycosis. Preoperative diagnosis is difficult due to the nonspecific nature of clinical presentation, radiographic and laboratory findings. Surgery combined with antibiotic treatment is a curative approach for this relatively rare infection. Surgeons must be aware of this disease in order to ensure correct diagnosis and to prevent performing any unnecessary procedures. The present study describes a case of abdominal actinomycosis with multiple myeloma, together with a review of important points related to this disease.

The Lymphoma Hidden in Actinomycosis

“…Predisposing factors such as gastrointestinal tract surgery or trauma, diabetes, lymphoma, extensive mucosal atrophy and medications such proton pump inhibitors facilitate this process. 2 , 3 In the present case, we believe that actinomycosis was facilitated by gastric mucosal damage caused by lymphoma. Due to its propensity to mimic many other diseases including malignancy and the difficulty of obtaining bacteriological evidence, early diagnosis of actinomycosis can be challenging.…”

“…It is a chronic suppurative infection caused by the anaerobic Gram-positive filamentous bacteria Actinomyces , usually Actinomyces israelii . 1 , 2 …”

Lesiones ocupantes de espacio en pared abdominal (no herniaria). La visión del patólogo

“…Los abscesos aparecen frecuentemente secundarios a una cirugía previa o de manera espontánea en pacientes diabé-ticos, inmunocomprometidos o en el curso de enfermedad de Crohn, diverticulitis o tuberculosis 6,7 . La actinomicosis se ha reportado en pacientes con neoplasias hematológi-cas y puede ocasionar lesiones ocupantes de espacio en la pared abdominal 7 .…”

“…Raramente puede observarse la transformación maligna de una endometriosis, que es muy difícil de diferenciar de una metástasis por adenocarcinoma en pared abdominal, al menos desde el punto de vista patológico. El diagnóstico diferencial se debe realizar con las fibromatosis, reacción granulomatosa con hemorragia, necrosis grasa, fascitis nodular (FN) y metástasis por adenocarcinoma de origen ginecológico o intestinal [1][2][3][4][5][6][7][8] .…”