Case Report: Acute large bowel obstruction with actinomycosis of the sigmoid colon mimicking neoplasm.

Introduction: Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation: A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Total colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion: Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.

Rheumatoid arthritis complicated with cervical actinomycosis and ureteral obstruction: A case report and literature review. / ç±»é£Žæ¹¿å ³èŠ‚ç‚Žåˆå¹¶å®«é¢ˆæ”¾çº¿èŒç— åŠè¾“å°¿ç®¡æ¢—é˜»1ä¾‹å¹¶æ–‡çŒ®å¤ä¹ .

Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts, often misdiagnosed due to its similarity to many infectious and non-infectious diseases. This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics, including methotrexate, leflunomide, and infliximab, leading to recurrent joint pain, poorly controlled rheumatoid arthritis activity, and persistent elevation of white blood cell counts. Abdominal CT revealed a pelvic mass and right ureteral dilation. Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules, indicating actinomycosis. The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide, hydroxychloroquine sulfate, and tofacitinib, resulting in improved joint symptoms and normalized white blood cell counts. After 2 years of follow-up, the patient remained stable with no recurrence. This case highlights the importance of clinicians being vigilant for infections, particularly chronic, occult infections from rare pathogens, in rheumatoid arthritis patients on potent immunosuppressants and biologics, advocating for early screening and diagnosis.

Mediastinal actinomycosis masquerading as a mass: a case of progressive dysphagia in an immunocompromised patient.

Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.

Successful Antimicrobial Therapy of Esophageal Stenosis Because of Actinomycosis.

Esophageal stenosis can cause vomiting or dysphagia in children and is commonly treated with esophageal balloon dilation. However, surgery may be required if the stenosis does not respond to dilation. Although esophageal actinomycosis can cause severe esophageal strictures and be refractory to balloon dilation, it has been reported to respond effectively to antimicrobial therapy in adults. However, the course of the disease and appropriate treatment strategies in children are not well understood. We present a case of a previously healthy 2-year-old boy diagnosed with esophageal stenosis because of actinomycosis. The patient was treated with intravenous penicillin G, followed by oral amoxicillin for 8 weeks and 6 months, respectively. After completion of the antimicrobial treatment, the patient showed improvement in symptoms and endoscopic findings. At the 1-year follow-up, the patient showed consistent weight gain and normal growth without further intervention. This case highlights the importance of considering esophageal actinomycosis as a potential cause of esophageal stenosis in children and the potential effectiveness of antimicrobial therapy in avoiding surgical intervention.

Actinomyces-induced Osteomyelitis of the Mandible - A Rare Disease?

BACKGROUND: Actinomyces species are commensal oral cavity flora that can cause jaw osteomyelitis. Osteomyelitis of the jaw by Actinomyces is rare, and its presentation can be confused with many different pathologies. CASE PRESENTATION: This is the case of a 61-year-old female with breast cancer and on chemotherapy as well as non-invasive carcinoma of the tongue who initially presented to the dentist with white spots in the right mandible near the incisors associated with right mandible pain and swelling. Actinomyces-induced osteomyelitis of the mandible was diagnosed. The patient was treated with penicillin V for 6 weeks along with a course of hyperbaric oxygen therapy, which resulted in the complete resolution of the infection. CONCLUSION: In summary, jaw osteomyelitis caused by Actinomyces should always be part of the differential diagnosis; as these organisms are commensal flora. The symptoms manifested are non-specific, and such a diagnosis could be easily missed, resulting in delay of care and disease progression.

Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report.

Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called Actinomyces israelii. The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity.

Massive hemoptysis as a complication of pulmonary actinomycosis: a case report.

Massive hemoptysis is a rare life-threatening complication of pulmonary actinomycosis that should be treated promptly due to the risk of asphyxiation and hemodynamic instability. We present the case of a 57-year-old female who was presented to our center with massive hemoptysis. Thoracic computed tomography scan revealed a cavitated lesion with perilesional ground-glass opacity. Right lower lobectomy was then performed using uniportal video-assisted thoracic surgery, excising a 13 × 12 × 8 cm cavitated lung fragment. The pathology service reported the presence of microscopical evidence of filamentous gram positive bacterial colonies, showing compatible features of pulmonary actinomycosis. The patient was discharged with oral penicillin with an uneventful post-operative course.

La hemoptisis masiva es una complicación poco frecuente de la actinomicosis pulmonar que pone en peligro la vida del paciente y que debe ser tratada con prontitud debido al riesgo de asfixia e inestabilidad hemodinámica. Presentamos una mujer de 57 años que acudió a nuestro centro con hemoptisis masiva. La tomografía reveló una cavitación con opacidad perilesional en vidrio deslustrado. Realizamos lobectomía mediante cirugía uniportal, extirpando un fragmento de lesión. Patología informó de la presencia de colonias bacterianas filamentosas grampositivas, mostrando características compatibles con actinomicosis pulmonar. El paciente fue dado de alta con penicilina oral, con un curso postoperatorio sin incidentes.

Clinical features and treatment outcomes of pulmonary actinomycosis.

OBJECTIVE: Pulmonary actinomycosis is a rare and chronic infectious disease that mimics malignancy and is frequently misdiagnosed. There are few reports that address the clinical characteristics of pulmonary actinomycosis. The objective of this research is to evaluate the clinical features, radiological findings, diagnostic approaches and treatment outcomes of pulmonary actinomycosis. PATIENTS AND METHODS: Thirty-seven patients with pulmonary actinomycosis histopathologically diagnosed from 2009 to 2021 were analyzed retrospectively. RESULTS: The mean age at presentation was 53.7 (±13.3) years. Frequent symptoms were cough and hemoptysis. The median diagnosis time from the first symptoms was 60 days (interquartile range 18-195). Pulmonary comorbidity was found in 59.5% of cases. The most common thorax computed tomography finding was mass or nodule. The low-attenuation center within the mass or consolidation was observed in 40% of the lesions. The median maximal standardized uptake value of lesions on positron emission tomography (PET) was 6.5 (interquartile range 2.7-10.3). In the majority of cases (97.3%), the diagnosis of pulmonary actinomycosis was not suspected at admission, and 56.8% of patients were misdiagnosed with lung cancer. The mean duration of antibiotic therapy was 9.4 days (range 3-22) with intravenous antibiotics and 64.7 days (range 5-270) with oral antibiotics. Four patients died due to concomitant comorbidities. Eight cases were lost to follow-up. All other cases were fully cured. CONCLUSIONS: Pulmonary actinomycosis mimics other diseases, often lung cancer. Clinicians should consider the diagnosis of actinomycosis when they detect a mass or consolidation, especially with a low-attenuation center. PET/CT appears not to be useful for differential diagnosis. A shorter course of antibiotic therapy than traditionally recommended appears to be sufficient.

A 57-year-old man with painful ophthalmoplegia and cavernous sinus involvement: Why this is not Tolosa-Hunt syndrome.

Tolosa-Hunt syndrome (THS) is an idiopathic condition included in the differential diagnosis of painful ophthalmoplegia. Although this was once a common diagnosis, the increasing availability of tests reveals an alternative etiology in many cases. Exclusion of treatable disorders is important, because the prognosis may otherwise be poor. We here describe a patient who presented with painful ophthalmoplegia with an infiltrating lesion in the cavernous sinus. Initially suspected of THS, he had a fatal evolution, and postmortem evaluation revealed cervicocephalic actinomycosis. Actinomycosis diagnosis is often missed, and still represents a challenge to the clinician. We highlight pearls and pitfalls to establish a proper diagnosis to avoid missing a treatable condition in patients with suspected THS.

Thoracoabdominal actinomycosis associated with laparoscopic cholecystectomy and mimicking metastatic pulmonary malignancy.

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.

Urachal Actinomycosis Presenting with Recurrent Urinary Tract Infections in a Middle-aged Woman: A Rare Case Report.

The urachal cyst, a remnant of allantois sac during embryogenesis, is a rare condition in adulthood. Urachus is an embryologic remnant degenerating after birth. Abberrant obliteration of the urachus causes urachal abnormalities. The urachal cysts are almost always symptomatic when infected. The symptoms include fever, abdominal pain, tenderness, lower abdominal mass, nausea, vomiting, and dysuria. Ultrasonography, computerised tomography, and magnetic resonance imaging techniques may be insufficient for diagnosis. In most cases, staphylococcus species are isolated from cultures of urachal cysts. Other microorganisms such as Escherichia coli, Enterococcus faecium, Klebsiella pneumonia, and rarely actinomyces may be isolated. Actinomyces, an anaerobic gram-positive filamentous bacterium, is a rare cause of granulomatous disease. In this case report, a 56-year woman with urachal cyst infection with actinomyces is discussed according to current knowledge. Key Words: Urachal cyst, Urachus, Chronic cystitis, Actinomyces.

Targeted histological evaluation shows high incidence of actinomyces infection in medication-related osteonecrosis of the jaws.

Medication-Related Osteonecrosis of the Jaws (MRONJ) is a difficult-to-treat complication of the therapy of osteoporosis and some malignancies cured with bisphosphonates and antiresorptive drugs. The pathomechanism is unclear, but there is increasing observation that Actinomyces infection may play a role in its development and progression. The aim of our study was to demonstrate that histological examination using a validated triple staining procedure for Actinomyces bacteria strains can detect a high rate of Actinomyces infection in patient's samples with MRONJ. 112 previously hematoxylin-eosin (HE) stained samples submitted with the clinical diagnosis of MRONJ were re-evaluated histologically using an appropriate triple special staining validated for the identification of Actinomyces infection. During the first evaluation, when pathologists did not specifically look for Actinomyces, only 8.93% of the samples were reported as positive. In contrast, re-evaluation with triple staining provided a yield of 93.7% positive samples, therefore, we suggest the triple special staining to be standard in MRONJ histology evaluation. These results show that if the clinician suspects Actinomyces infection and brings this to the attention of the pathologist, it could significantly increase the number of correct diagnoses. It serves as an aid for clinicians in therapeutic success of MRONJ by selecting a long-term adequate antibiotic medication which is suitable for the elimination of actinomyces infection.

[Pulmonary actinomycosis caused by Actinomycesodontolyticus in a two-year-old child]. / Actinomycose pulmonaire à Actinomycesodontolyticus chez un enfant de 2 ans.

INTRODUCTION: Pulmonary actinomycosis due to Actinomyces Odontolyticus is a rare and seldom reported pathology in pediatrics. The unspecific radio-clinical symptomatology and the slow growth of the germ make the diagnosis difficult. CASE REPORT: A 2-year-old boy is admitted to the emergency room for acute respiratory distress in a context of febrile bronchitis that had been evolving for 10days. Quickly, the patient's state deteriorate, invasive ventilation was required. Bronchial fibroscopy was performed immediately and enabled extraction of large mucous filaments, leading to significant improvement. Mechanical ventilation was stopped after 72hours. Five days later, blood culture tested positive for Actinomyces Odontolyticus. In the absence of any other cause and given a compatible clinical picture, the child was treated with long-term antibiotherapy for a total duration of 6months, which was stopped following reassuringly normal endoscopic and radiological control. CONCLUSIONS: This is the second pediatric case of pulmonary actinomycosis due to A. Odontolyticus reported in the literature. The clinical symptoms and imaging are not specific. The presence of sulphide granules on pathological examination or in germ culture at a sterile site confirms the diagnosis. Prolonged antibiotic therapy is still recommended to avoid pulmonary sequels.

Actinomyces meyeri causing disseminated actinomycosis in the presence of concurrent bronchogenic carcinoma.

We describe the presentation of a 72-year-old woman with concurrent diagnoses of lung adenocarcinoma in conjunction with disseminated Actinomyces meyeri infection; a rare pathogen which can mimic lung cancer both symptomatically and radiologically. The patient was found to have a pelvic mass initially presumed to be cervical metastases-later confirmed to be of xanthogranulomatous inflammatory origin following transvaginal ultrasound-guided biopsy. The pathogenic cause, identified following pleural aspirate, being a fully sensitive A. meyeri infection; treated with prolonged course amoxicillin.

Giant sialolith associated with Actinomyces infection, suggesting a new etiopathogenic correlation: a case report.

Sialolithiasis is a disorder of the salivary glands characterized by the presence of mineralized structures. The aim of this article is to contribute to the understanding of the etiopathogenesis of sialolithiasis based on data reported in the literature and the interpretation of scanning electron microscopic (SEM), histopathologic, fluorescence, and energy-dispersive X-ray spectroscopic (EDX) studies. The results of these analyses in a single case are presented. Fluorescence microscopy captured saliva flowing inside a giant sialolith, EDX analysis enabled the quantification of samples of minerals and characterized the chemical composition in the internal areas of the sialolith, and SEM images captured the external communications of the sialolith (ostia). Many theories have been proposed to explain sialolithiasis development, but few consider the role of saliva in its dynamic form. The authors propose that the triple synergism of microbiota, biofilm, and salivary dynamics plays a fundamental role in the development and intrinsic architecture of sialoliths, creating a cyclic sialolithic mineralization. This hypothesis is supported by the results of the laboratory studies in the present case.