Pelvic actinomycosis with secondary liver abscess, an unusual presentation

O’Kelly, Kate; Abu, Jafaru; Hammond, Robert; Jensen, Mary Lee; O'Connor, RE; Soomro, Irshad

doi:10.1016/j.ejogrb.2012.04.009

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Los dos casos aquí descritos presentaron una tumoración abdomino-pélvica de consistencia pétrea, que es la modalidad más frecuente descrita en la literatura, en ocasiones asociada con plastrón pélvico 4,6,7,13,16,17,[19][20][21][22] .…”

Section: Discussionunclassified

“…Sin embargo, estos nódulos correspondieron a la diseminación hematógena de la actinomicosis y remitieron totalmente luego del tratamiento antibiótico realizado, tal como se demostró por la desaparición de estas imágenes en la TC de control. Este caso es uno de los pocos reportes publicados en que se da a conocer la diseminación sistémica de la API, con localizaciones secundarias, como el hígado y el pulmón 12,21,22 .…”

Section: Discussionunclassified

“…El diagnóstico de API se sospecha en toda paciente usuaria de DIU por un tiempo superior a 10 años, habitualmente sin control [3][4][5][6][7][8][10][11][12][13][14][15][16][17][18] , con tumor ginecológico, que en la exploración pélvica manual es de contornos imprecisos, aplastronado, de consistencia firme leñosa (casos 1 y 2) 3,4,6,7,16,24 . Se confirma el diagnóstico por biopsia quirúrgica de los granulomas, obtenida por laparoscopía exploradora (caso 1), laparotomía exploradora (caso 2) 4,5,18 , punción percutánea con aguja fina o guiada por ultrasonido 3,22 , o por biopsia de endometrio tomada por vía vaginal con Pipelle 22,23 , procedimiento ambulatorio, fácil de realizar y de alta sensibilidad. Las imágenes obtenidas por ecografía, y especialmente por TC, son complementarias para hacer el diagnóstico diferencial entre API y cáncer de órganos pélvicos, así como para controlar la evolución y la respuesta al tratamiento 3,17,[24][25][26][27] .…”

Section: Discussionunclassified

“…Se origina una masa pélvica fibrosa, descrita como «pelvis congelada o sellada», por la incapacidad de liberar las estructuras comprometidas durante la cirugía. La API se denominada «pseudotumoral» porque se presenta como tumor pélvico complejo con características imagenológicas inespecíficas, que a menudo se confunden con neoplasia [2][3][4]6,7,[11][12][13][14][15][16][17][18][19][20][21][22] y supuestas metástasis, que corresponden a la diseminación hematógena a distancia de la infección, por lo que el diagnóstico y el manejo representan un gran desafío para el ginecólogo.…”

Section: Introductionunclassified

“…El tratamiento es con antibióticos betalactámicos de uso prolongado 1,3,4,7,10,11,13,17,22 , comúnmente administrados por vía intravenosa los primeros días, para luego continuar con la vía oral hasta completar 3 a 6 meses. La penicilina G y sus derivados son los antimicrobianos de elección 3,7,8,10,11,13,21 .…”

Section: Introductionunclassified

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Actinomicosis pélvica invasiva. Un desafío para el ginecólogo

Cisterna¹,

Ovalle²

2021

RECHOG

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La actinomicosis pélvica es una infección bacteriana supurativa crónica, producida por especies de Actinomyces, principalmente Actinomyces israelii, que afecta el aparato genital interno y las estructuras vecinas, asociada al uso prolongado de dispositivo intrauterino sin control en casi la totalidad de los casos descritos en mujeres. La actinomicosis pélvica suele presentarse como un absceso tubo-ovárico y con menor frecuencia como una actinomicosis pélvica invasiva (API). La API se propaga por contigüidad desde el aparato genital hacia las vísceras adyacentes, originando un tumor pélvico difuso, de consistencia leñosa, pseudotumoral, que a menudo se confunde con una neoplasia pélvica. La API representa un gran desafío para el ginecólogo por las dificultades en su diagnóstico y manejo. Se presentan dos casos de API y se revisan los procedimientos diagnósticos y terapéuticos recomendados actualmente para el enfrentamiento de esta patología.

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Section: Discussionunclassified

Section: Introductionunclassified

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Actinomicosis pélvica invasiva. Un desafío para el ginecólogo

Cisterna¹,

Ovalle²

2021

RECHOG

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A systematic review of case reports of hepatic actinomycosis

Chegini

Didehdar

Tabaeian

et al. 2021

Orphanet J Rare Dis

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Background Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. Methods Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline. Results Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection. Conclusion HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.

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Hepatic actinomycosis: Report of one case and analysis of 32 previously reported cases

Yang

Lin

et al. 2014

WJG

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Hepatic actinomycosis is rare, with few published cases. There are no characteristic clinical manifestations, and computed tomography (CT) shows mainly low-density images, making clinical diagnosis difficult, and leading to frequent misdiagnosis as primary liver cancer, metastatic liver cancer or liver abscess. Diagnosis normally requires examination of both the aetiology and pathology. This article reports one male patient aged 55 who was hospitalized because of repeated upper abdominal pain for more than 2 mo. He exhibited no chills, fever or yellow staining of the skin and sclera, and examination revealed no positive signs. The routine blood results were: haemoglobin 110 g/L, normal numbers of leukocytes and neutral leukocytes, serum albumin 32 g/L, negative serum hepatitis B markers and hepatitis C antibodies, normal tumour markers (alpha-fetoprotein and carcinoembryonic antigen). An abdominal CT scan revealed an 11.2 cm × 5.8 cm × 7.4 cm mass with an unclear edge in the left liver lobe. The patient was diagnosed as having primary liver cancer, and left lobe resection was performed. The postoperative pathological examination found multifocal actinomycetes in the hepatic parenchyma, which was accompanied by chronic suppurative inflammation. A focal abscess had formed, and large doses of sodium penicillin were administered postoperatively as anti-infective therapy. This article also reviews 32 cases reported in the English literature, with the aim of determining the clinical features and treatment characteristics of this disease, and providing a reference for its diagnosis and treatment.

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Pelvic actinomycosis with secondary liver abscess, an unusual presentation

Cited by 3 publications

References 5 publications

Actinomicosis pélvica invasiva. Un desafío para el ginecólogo

Actinomicosis pélvica invasiva. Un desafío para el ginecólogo

A systematic review of case reports of hepatic actinomycosis

Hepatic actinomycosis: Report of one case and analysis of 32 previously reported cases

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