Hepatic Actinomycosis

Abstract

Actinomycosis is a rare disorder caused by an anaerobic gram-positive bacillus (Actinomyces), predominantly by the Actinomyces israelii species. Only 20% of cases show an abdominal manifestation, the appendix and ileocecal valve being the most frequent locations. Definitive diagnosis is based on microbiological cultures, microscopy or macroscopy examination. Nevertheless, histological examination of the percutaneous biopsy and blood microbiological cultures are rarely positives. Preoperative diagnosis is hampered by the lack of specific clinical and imaging manifestations, which often mimic malignancy. The rate of preoperative diagnosis is less than 10%, however, the outcome is excellent, with a low mortality rate. The authors describe the case of a patient who was diagnosed with primary hepatic actinomycosis only by a histological examination of the surgical specimen of left hepatectomy extended to segments V and VIII, for suspected malignant lesion. This case demonstrates the difficulties in diagnosing hepatic actinomycosis.

Hepatic Actinomycosis in a Patient With Retained Common Bile Duct Stent

“…Abdominal actinomycosis is less frequent, comprising about 20% of cases. 1 Most of these cases occur in the appendix or ileocecal region, with hepatic infection occurring in ∼5% of this already rare infectious process. 1 Most hepatic actinomycosis cases arise from other intra-abdominal infections resulting from loss of integrity of the gastrointestinal mucosa, previous abdominal surgeries, foreign bodies, or immunosuppression.…”

“…1 Most of these cases occur in the appendix or ileocecal region, with hepatic infection occurring in ∼5% of this already rare infectious process. 1 Most hepatic actinomycosis cases arise from other intra-abdominal infections resulting from loss of integrity of the gastrointestinal mucosa, previous abdominal surgeries, foreign bodies, or immunosuppression. 2 In this case, the patient had a sphincterotomy with a retained common bile duct stent, which most likely caused a breach in the gastrointestinal integrity and the presence of foreign body in the biliary tree, serving as the nidus of infection.…”

“…Abdominal actinomycosis represents a minority of cases, with hepatic actinomycosis representing only one-fourth of intra-abdominal occurrences. 1 When hepatic actinomycosis does occur, it is usually secondary to another intra-abdominal source. 2 There are no previous cases reporting retained biliary stents causing primary hepatic actinomycosis.…”

Actinomycotic hepatic abscess in woman with longstanding intrauterine contraceptive device

“…Biochemical results are usually normal, with the exception of anemia, leukocytosis, and often elevated CRP and erythrocyte sedimentation rate [4,7,19]. Mildly increased alkaline phosphatase, lower albumin levels and elevated tumor markers (AFP, CA 19.9) are occasionally found in patients with hepatic actinomycosis [7,20].…”

“…Abdominal US, CT and magnetic resonance imaging (MRI) imaging show single (66%) or multiple (33%) liver masses/abscesses [20]. US shows hypoechoic, heterogeneous and sometimes poorly defined lesions [20]. CT and MRI reveal nodular hepatic lesions, sometimes multilocular, lobulated, with undefined boundaries.…”