Abdominal actinomycosis masquerading as colon cancer in a liver transplant recipient

Abstract

Infections in transplant recipients are associated with high morbidity and mortality, making their early recognition and treatment particularly important. Abdominal actinomycosis is a rare clinical entity and difficult to diagnose because of its various and nonspecific features. We describe a 57-year-old patient who presented with abdominal actinomycosis simulating colon cancer 6 years after liver transplantation. The main symptom was abdominal pain. Abdominal computed tomography and colonoscopy revealed an intraluminal 4.5 cm mass in the right colon, raising suspicions of a colonic malignancy and leading to surgical intervention. The postoperative pathologic study showed sulfur granules in the resected specimen compatible with abdominal actinomycosis. No signs of recurrence were seen throughout the 6-month follow-up. The literature on actinomycosis infections in immune-compromised hosts is reviewed. This presentation of actinomycosis in a liver transplant recipient has not been described previously, to our knowledge.

Patient with protracted abdominal pain

“…Species that are commonly associated with human infections are Actinomyces israelii, A. naeslundii, A. odontolyticus, A. viscosus, A. meyeri and A. gerencseriae. 3 At times referred to as "the most undiagnosed disease", 4 this infection can mimic a wide range of conditions and is often missed, if not actively excluded. 1 It should be included in the differential diagnosis of most cases of unconfirmed malignancy as it has been described in this context on numerous occasions.…”

“…16 Currently, there are less than 100 case published reports in the English literature. 4 Very rarely, the central nervous system can be involved via either direct extension or haematogenous spread. 1 Of these cases, brain abscesses seem to be the most common presentation.…”

“…21 No radiological features are considered to be specific for actinomycosis 19,20,22 and the diagnosis is rarely established preoperatively based on the radiological findings. 4 Histopathology can greatly facilitate in establishing a diagnosis of actinomycosis. The demonstration of sulphur granules, consisting of Gram-positive filamentous organisms, is highly supportive of this diagnosis.…”

Abdominopelvic Actinomycosis Associated With an Intrauterine Device and Presenting With a Rectal Mass and Hydronephrosis: A Troublesome Condition for the Clinician

“…Tetracyclines, doxycycline, erythromycin, clindamycin, or cephalosporins are suitable alternatives in patients who are allergic to penicillin. 1,2,5,6,9,12,17,18 A few previous studies have suggested that antimicrobial therapy should be continued until all signs of inflammation disappear, which can take from several months to 1 year because of the reactive fibrosis caused by the organism. 6 We share the same opinion about the duration of medical treatment.…”

“…[2][3][4] Any disease or process that causes a breach in the protective mucosa, such as perforation of a viscus, surgery, trauma, or use of an intrauterine device (IUD), can be complicated by the proliferation of Actinomyces. 4,5 Pelvic actinomycosis has recently become more prevalent and is associated almost exclusively with women who use IUDs. Diagnosing abdominopelvic actinomycosis preoperatively presents a challenge to the clinician because of the rarity and clinical variety of this condition.…”