Renal hemorrhagic actinomycotic abscess in pregnancy

Abstract

Actinomyces israelii is a gram-positive, filamentous anaerobic bacteria colonizing the oral and gastrointestinal tracts. Retroperitoneal actinomycotic abscess is uncommon and its rare presentation as a hemorrhagic mass may be confused with malignancy. We present a case of this unusual infection complicating pregnancy. Increased awareness of actinomycotic abscess in the differential diagnosis of renal mass concerning for malignancy is critical to early recognition and treatment of this rare infection and most importantly, avoidance of unnecessary surgical intervention.

Actinomyces in Pregnancy: A Review of the Literature

“…In our literature review, we identified 16 cases of Actinomyces in pregnancy (Table 1), [6][7][8][9][10][11][12][13][14][15][16][17][18][19] and we have had a single case at our hospital. We were unable to obtain 1 article from Croatia.…”

“…14,19 There were 4 cases of a dental abscess, 7,13,18 2 cases of appendicitis, 9,12 2 cases of renal actinomycosis (1 of which also had a tooth abscess 13 ), 16 and 2 cases of ovarian abscesses. Two of these cases had a cervical cerclage.…”

“…10,17 Only 2 of the case reports noted an IUD history among the 17 patients. 10,[14][15][16]18 A potential concern of identifying Actinomyces in pregnant patients is that for most of these patients, the antibiotics chosen to treat the infection in pregnancy are also effective in treating Actinomyces. Endometrial actinomycosis with extension to the fallopian tubes and ovaries is a form of pelvic actinomycosis that has been commonly associated with IUDs.…”

“…Another limitation was that there was no evaluation of organisms in the amniotic fluid and no pathologic examination of the placenta. 8,10,16,17 All of these patients required surgical resection of the distant site of infection. Actinomyces naeslundii was one of the 2 commensal species evaluated.…”