Spontaneous Bacterial Peritonitis due to Actinomyces Mimicking a Perforation of the Proximal Jejunum

Abstract

Patient: Female, 42Final Diagnosis: Spontaneous pelvic-abdominal peritonitis due to actinomycesSymptoms: Abdominal distension • abdominal pain • acute abdomen • fever • intermenstrual bleeding • nausea • sepsis • septic shockMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Unusual clinical courseBackground:Pelvic-abdominal actinomycosis is a rare chronic condition caused by an anaerobic, gram-negative rod-shaped commensal bacterium of the Actinomyces species. When Actinomyces becomes pathogenic, it frequently causes a chronic infection with granulomatous abscess formation with pus. Due to diversity in clinical and radiological presentation, actinomycosis can easily be mistaken for several other conditions. Peritonitis without preceding abscess formation caused by Actinomyces species has been described in only few cases before in literature.Case report:We report a case of spontaneous pelvic-abdominal peritonitis with presence of pneumoperitoneum and absence of preceding abscesses due to acute actinomycosis mimicking a perforation of the proximal jejunum in a 42-year-old female with an intra-uterine contraceptive device in place. Explorative laparotomy revealed 2 liters of odorless pus but no etiological explanation for the peritonitis. The intra-uterine contraceptive device was removed. Cultivation showed growth of Actinomyces turicensis. The patient was successfully treated with penicillin.Conclusions:In the case of primary bacterial peritonitis or lower abdominal pain without focus in a patient with an intrauterine device in situ, Actinomyces should be considered as a pathogen.

Spontaneous Bacterial Peritonitis Because of Actinomyces

“…The endogenous infection occurs because of disruption of the epithelial mucosal barrier surfaces secondary to trauma, foreign body or surgical procedures, immunosuppression, or a perforated bowel. [1][2][3]6 Rarely, the hematogenous spread of the infection to the liver and lungs can present as a nodule or mass on imaging and resemble malignancy. 10 The 3 primary clinical forms of actinomycosis described are cervicofacial, thoracic, and abdominopelvic.…”

“…[1][2][3][4] They can cause endogenous infection because of disruption of the epithelial surfaces secondary to trauma, foreign body, or surgical procedures called actinomycosis. [1][2][3]5,6 Actinomycosis is a chronic, slowly progressing granulomatous infection that can lead to abscess formation, necrosis, adhesions with surrounding structures, and/or sinus tract formation. 7 Because of the indolent nature of the infection and nonspecific symptoms, the diagnosis and treatment are often delayed.…”

“…Actinomyces are commensal flora in the oropharynx, urogenital, and gastrointestinal tract. [1][2][3][4] They can cause endogenous infection because of disruption of the epithelial surfaces secondary to trauma, foreign body, or surgical procedures called actinomycosis. [1][2][3]5,6 Actinomycosis is a chronic, slowly progressing granulomatous infection that can lead to abscess formation, necrosis, adhesions with surrounding structures, and/or sinus tract formation.…”

Mesenterialis actinomycosis

“…A betegség, amelynek tünetei nem specifikusak, krónikus gyulladást, malignus folyamatot utánozhat, a leggyakrabban az appendixet érinti, és jellemző a leukocytosis is [4]. Eenhuis és mtsai viszont akut hasi kórképet utánzó, pneumoperitoneumot okozó actinomycosisról számoltak be [5]. Amennyiben komplikált hasűri fertőzés formájában jelentkezik a betegség, a szepszis diagnó-…”

The cytopathology of Actinomyces, Nocardia, and their mimickers

“…Typically, these effusions present secondary to associated mass lesions or pseudotumors. Rare reports of spontaneous peritonitis due to Actinomyces without preceding abscess formation or inciting event have been described, and in the single report with cytologic preparations, sulfur granules were microscopically identified . On macroscopic examination, these effusions range from serosanguinous to densely purulent, and cytology may not always detect the bacteria .…”