Appendicular Actinomycosis: Behind the Curtains of Appendicitis

Abstract

Actinomycosis is a rare, indolent, and multisystemic infection caused by Actinomyces, commensal bacteria of the oral and intestinal flora. It usually occurs due to tissue disruption. It affects the abdominal region in 20% of cases, and the most common presentation is a perforated appendix. Symptoms are nonspecific, which makes differential diagnosis a challenge.We present the case of a healthy, nine-year-old boy of African ancestry with a five-month history of recurrent intermittent abdominal pain in the periumbilical and right lower quadrant areas. He recurred to the emergency department with symptoms suggestive of acute appendicitis and was submitted to an emergent laparotomy. The histologic examination revealed Actinomyces colonies compatible with the diagnosis of appendicular actinomycosis. He was treated with intravenous penicillin for a month and, subsequently, with oral amoxicillin for a year. He had complete remission of symptoms.Actinomycosis is a rare entity, particularly in children. Nevertheless, it should be considered in the differential diagnosis of an intrabdominal mass or unspecific recurrent, indolent, and abdominal pain. As symptoms are nonspecific, it can mimic other diseases. It is mostly diagnosed post-operatively, after histological examination. Early treatment is important to avoid recurrence, and, therefore, a high index of suspicion is required.

Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal

“…A retrospective study of 1627 appendectomy specimens showed only one case (0.06%) of actinomycosis, 1 whereas the evaluation of 3602 appendicectomy specimens in another study showed only a case of actinomycosis (0.02%). 2 There are few cases reported for actinomycosis of the appendix [5][6][7][8][9][10][11] ; however, this study seems to be the first of its kind to be reported from the country.…”

“…Actinomycosis is a rare infectious disease caused by actinomyces species, which is a gram‐positive anaerobic bacterium 3,4 . Despite the clear statistical data, an incidence of 0.3–1 incident per year per 100,000 people has been estimated 5 . It occurs as a commensal in the oral cavity, gastrointestinal tract, and female genital tract, and becomes pathogenic when the mucosal barrier is breached 3,4,7 .…”

“…The commensal microbiota of the intestinal mucosa, oral cavity, and urogenital tract, known as actinomyces, frequently manifests as perforated appendicitis 3,4 . Preoperative diagnosis continues to be challenging considering the symptoms are nonspecific and the condition mimics other abdominal ailments such as intestinal tuberculosis, cancer, or inflammatory bowel disease 5,6 …”

“… 3 , 4 Preoperative diagnosis continues to be challenging considering the symptoms are nonspecific and the condition mimics other abdominal ailments such as intestinal tuberculosis, cancer, or inflammatory bowel disease. 5 , 6 …”

“…3,4 Preoperative diagnosis continues to be challenging considering the symptoms are nonspecific and the condition mimics other abdominal ailments such as intestinal tuberculosis, cancer, or inflammatory bowel disease. 5,6 On searching PubMed, with keywords (actinomycosis) AND (Nepal), actinomycosis affecting the esophagus, skin, gall bladder, and brain was reported, however, could not find the cases of appendicular actinomycosis reported from Nepal, so might be the first case to be reported from…”