A 38-year-old man was admitted to our hospital with a major complaint of 15-day abdominal pain in the upper right quadrant and intermittent fever of 38 C. Physical examination revealed tenderness in the upper right quadrant. Laboratory tests including white blood cell count, alanine aminotransferase, bilirubin and alpha fetoprotein were all normal. Computed tomography (CT) revealed an approximately 6 × 6 cm 2 hypodense mass in the left lateral segment of the liver. Enhanced CT scan of the mass demonstrated continued enhancement, that is, relatively low density in the artery phase and relatively high density in the equilibrium phase ( Fig. 1). The surface of the left lobe was blurred, leading to suspicion of a tumour infiltrating into the surrounding tissue. The above findings were highly suggestive of hepatic malignant tumour and thus surgical resection was scheduled. Intraoperatively, a firm mass of 6 cm in diameter at the base of segments II and III was found, which adhered to the anterior abdominal wall and diaphragm. There were yellowish nodules and necrotic tissue inside the mass. The left lobectomy of the liver was then performed. Macroscopically, the resected liver showed a yellowish-white mass that contained frequent pus-like areas. Histological examination revealed an abscess containing multiple aggregates of acute and chronic inflammatory infiltrates with florid fibrosis. Notably, several clusters of filamentous microorganisms consistent with actinomyces colonies (socalled sulphur granules) were present (Fig. 2). Filamentous bacteria were detected in the sulphur granules and positive for Gram staining. The overall features were those of primary hepatic actinomycosis (PHA). Thus, the diagnosis was confirmed to be PHA. The patient received intravenous cefoperazone for 7 days after the surgery and fully recovered and discharged. He was followed-up for 2 years and remained uneventful.PHA occurs worldwide, but only 87 cases were reported in English literature between 1966 and 2015; 1-6 none of them were from mainland China. This case prompted us to review PHA cases reported from mainland China in Chinese literature, and share the © 2016 Royal Australasian College of Surgeons ANZ J Surg 88 (2018) E629-E630
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