Thoracoabdominal actinomycosis associated with laparoscopic cholecystectomy and mimicking metastatic pulmonary malignancy

Abstract

Actinomyces naeslundii is rarely isolated in cases of actinomycosis. We present a case of thoracoabdominal actinomycosis caused by inadvertent enterotomy and gallstone spillage during a laparoscopic cholecystectomy. The actinomycosis initially presented as recurrent episodes of pneumonia, shortness of breath and unintentional weight loss. Initial CT imaging demonstrated pleural thickening along the right lung base as well as ill-defined consolidation in the right lower lobe. Repeat CT imaging showed progression of the mass-like region of consolidation with extrapulmonary spread to involve the abdomen, retroperitoneum and retrohepatic areas. Treatment involved intravenous antibiotics with concurrent abscess drainage followed by oral antibiotics.

Systematic exploration of the causal relationships among gallstones, cholecystectomy, and 33 types of site-specific cancers: A Mendelian randomization study based on after-meta analysis

“…This nding substantiates our own investigation proposing a plausible causal association between gallstones and lung cancer. However, several case studies have suggested that the occurrence of lung cancer in patients with gallstones may be due to the surgical displacement of gallstones leading to a thoracic in ammatory reaction and subsequent malignant transformation [47][48][49]. Moreover, previous research has indicated that alterations in the bile acid composition can activate FXR receptors within hepatic or intestinal epithelial cells, thereby modulating in ammation and immune responses.…”