491/603. Childhood actinomycosis: report of two cases. The authors report two cases of actinomycosis in children: one thoracic and the other retroperitoneal. They emphasize the difficulties of diagnosis before the stage of parietal extension with cutaneous fistula and characteristic yellow granular discharge. These difficulties are due to: The rarity of visceral actinomycosis, particularly in children. The lesion has a similar appearance to that of a tumor; an extensive pre-operative work-up is mandatory (ultrasound, computed tomogram scan, repeated ultrasound-guided needle biopsy), although this work-up may not necessarily lead to the correct diagnosis. A surgical biopsy will often confirm the diagnosis, provided the diagnosis has been previously considered. The necessity of using very specific tests for correct identification of the organism. Therefore, in a case of pseudo-inflammatory pseudotumor, visceral actinomycosis must be considered in order to guide microbiological and pathological studies, although this diagnosis is rare. Once the diagnosis has been made, prolonged treatment with penicillin is effective and complete recovery is generally obtained. ( info) |
492/603. Hepatic actinomycosis: a case report. A 64-year-old man with hepatic actinomycosis presented with several months of weight loss and poor appetite. However, no fever was noted before admission. Findings on abdominal sonography and computed tomography scan were suggestive of hepatocellular carcinoma. A sono-guided percutaneous liver biopsy specimen demonstrated only chronic fibrosing inflammation. Therefore, laparotomy was performed and the diagnosis of hepatic actinomycosis was established after surgical resection. The patient was then successfully treated. The fact that hepatic actinomycosis may be very similar to hepatocellular carcinoma should be highly suspected. The hospital course of this patient concerning this condition and a brief review of the literature are presented to illustrate the diagnostic difficulties which may be encountered in such cases. ( info) |
493/603. Extensive colonic stricture due to pelvic actinomycosis. A 36-year-old woman presented with a palpable tender mass at the left lower quadrant of the abdomen. She had suffered from constipation for five years and had a previous history of intrauterine device-use for one year. Preoperative barium enema and abdominopelvic CT showed a compatible finding of rectosigmoid colon cancer or left ovary cancer. She underwent segmental resection of the sigmoid colon along with the removal of left distal ureter, left ovary and salpinx. Pathologic examination revealed actinomycotic abscesses containing sulfur granules. Thereafter, she took parenteral ampicillin (50mg/kg/day) for one month and oral amoxicillin (250mg, tid) for 2 months consecutively. The patient has no specific problems for 6 months after surgical resection and long-term antibiotic therapy. This report may be the first of intrauterine device-associated pelvic actinomycosis involving both sigmoid colon and rectum extensively. ( info) |
| Several recent reports have indicated the possible association between pelvic infection caused by actinomyces and the use of intrauterine contraceptive devices. Seven cases of infection or colonization of the female genital tract have been detected among women using intrauterine contraceptive devices (IUD's) at Grady Memorial Hospital, Atlanta, georgia, from March, 1975, until May, 1977. No single IUD type has been incriminated. The shortest duration of consecutive IUD use before the diagnosis was two and a half years. Six of these cases were detected incidentally at the time of endometrial or endocervical biopsy. The diagnosis in each case was made histologically. One patient presented with severe pelvic inflammatory disease and had actinomyces identified. This is the first reported death associated with pelvic actinomycosis in a woman using an IUD. This organism must be considered as a possible pathogen whenever a patient with an IUD develops pelvic inflammatory disease. ( info) |
495/603. Ciliated hepatic foregut cyst. Report of a case with findings on fine needle aspiration. Ciliated hepatic foregut cyst (CHFC) is an uncommon cystic lesion of the liver. It is analogous in nature and pathogenesis to the bronchial cysts that occur in the mediastinum. We report a case of CHFC diagnosed on fine needle aspiration (FNA) with a discussion of the cytologic findings and features and a review of the literature. Abdominal computed tomography (CT) detected the lesion during a workup for metastatic squamous cell carcinoma of the cervix in a patient with an intrauterine contraceptive device and uterine actinomyces infection. Subsequent CT-guided FNA produced clear, viscid material that revealed numerous macrophages and scattered ciliated columnar cells within the mucinous background. The cytology and radiologic findings were essentially similar to those of a bronchial cyst and did not conform to any of the findings in generally known lesions of the liver. awareness of this rare hepatic lesion will result in an accurate and definitive diagnosis by guided FNA biopsy and avoidance of surgical exploration and excision biopsy. ( info) |
| This report describes the first case of biliary actinomycosis associated with an adenocarcinoma of the gallbladder. actinomyces naeslundii was encountered as a pure isolate after a precise and careful identification. Although, in diagnosis, cancer and actinomycosis are often confused, the simultaneous occurrence of actinomycosis in cancer lesions can happen. This case illustrates the diagnostic challenge of actinomycosis. ( info) |
497/603. Intramural gastric actinomycosis. We report a case of intramural gastric actinomycosis and review the features of the additional 16 cases of this uncommon infection reported in the literature. The patient had gastrointestinal symptoms, weight loss, and fever after gastric operation. At laparotomy, an infiltrating gastric tumor-like lesion was found. histology revealed actinomycosis, and the patient was successfully treated with oral penicillin. Because of its rarity, intramural actinomycosis is an entity overlooked by most surgeons. Reporting of such cases may help increase the awareness of this important and curable disease. ( info) |
498/603. Sclerosing osteomyelitis and actinomyces naeslundii infection of surrounding tissues. We present the case of a young man with chronic actinomyces naeslundii infection in the lower leg who underwent a below-the-knee amputation after unsuccessful attempts at diagnosing and eradicating the infection. Actinomycetic organisms from environmental sources can engender a dense fibrotic tissue response without fistulae. Such a response led to a painful, sclerosing, nonsuppurative infection of the bone and surrounding tissues in our patient. This clinical picture, at least the bony and periosteal reaction, was compatible with Garre's osteomyelitis. ( info) |
499/603. Necrotizing funisitis associated with actinomyces meyeri infection: a case report. Necrotizing funisitis is associated with an increased rate of stillbirth, perinatal infection, and preterm delivery. No one organism has been associated with necrotizing funisitis, although this condition has been linked with congenital syphilis in some studies. We report a case of necrotizing funisitis in a 24-year-old G2P0A2 woman who experienced preterm labor at 31 weeks of gestation. Examination of the placenta revealed severe chorioamnionitis and necrotizing funisitis; large numbers of gram-positive filamentous branching organisms could be seen on the surface of the cord and within wharton jelly. Initial cultures of the placenta, which had not been maintained under anaerobic conditions after delivery, were negative. A fragment of the cord was then homogenized; anaerobic culture on brain-heart infusion agar yielded actinomyces meyeri. This organism usually resides in the periodontal sulcus and has not been previously reported in the female genital tract. The mother gave a history of a dental abscess that flared up and drained with each of her three pregnancies; the pain was particularly severe during the last 2 months of this pregnancy, so she had the tooth removed after delivery. The infant was treated for prematurity and presumed sepsis and did well. ( info) |
500/603. Chest wall actinomycosis in association with the use of an intra-uterine device. A 31 year old woman presented with a chest wall abscess due to actinomyces israellii and porphyromonas asaccharolytica (previously bacteroides asaccharolyticus). She was a long-term user of an intra-uterine device (IUD) and, although asymptomatic, had radiological evidence of pelvic infection. actinomyces-like organisms were seen on cervico-vaginal smears. The abscess was surgically drained, the IUD removed, and a prolonged course of amoxycillin/clavulanic acid given. ( info) |