A 72-year-old man presented to the emergency department with a history of fever, general malaise, anorexia, and weight loss of 5-6 kilos over the last 3-4 months. He was diagnosed with diabetes mellitus before 7 years. He had no history of abdominal surgery or gastrointestinal intervention. On physical examination, his body temperature was 39.5°C and his abdomen was soft and non-tender. Abdominal ultrasonography revealed a heterogeneous hypoechoic lesion area measuring 90 × 50 mm in the right lobe of the liver. Abdominal computed tomography showed an irregular limited lesion (Figure 1). The patient had fever (39°C-40°C) 2-3 times a day with severe chills, after which cultures were performed and empiric ceftriaxone 2 g/day (IV) was initiated.
The hepatic abscess was evacuated (Figure 2). Cytopathological examination revealed neutrophils, histiocytes, and Actinomyces colonies. The patient was treated with intravenous penicillin G for 45 days and was discharged on treatment with oral ampicillin. The follow-up abdominal magnetic resonance imaging after 2 months revealed no abnormalities (Figure 3). The treatment was completed in 6 months.
Abdominal computed tomography: an irregular limited lesion area with a contoured lobule measuring 110 × 60 mm in the right lobe of the liver (arrows).
Actinomyces are anaerobic or microaerophilic gram-positive filamentous bacteria that normally colonize the mouth, colon, and vagina11. Russo TA. Agent of Actinomycosis. In: Mandell GL, Bennett JE, Dolin R editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8 th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015 V:2, p. 2864-73.,22. Kim SB, Kim JW, Choi JH. A Rare Cause of Multiple Hepatic Masses. Gastroenterology. 2019;157(3):e12-e13.. Hepatic involvement is present in 5% cases of actinomycosis. While hepatic involvement may be seen in disseminated actinomycosis, isolated involvement is most likely due to a hematogenous spread from an unknown focus.
In the differential diagnosis of liver abscesses, isolated liver actinomycosis should also be considered in patients without a history of abdominal surgery.
References
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1Russo TA. Agent of Actinomycosis. In: Mandell GL, Bennett JE, Dolin R editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8 th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015 V:2, p. 2864-73.
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2Kim SB, Kim JW, Choi JH. A Rare Cause of Multiple Hepatic Masses. Gastroenterology. 2019;157(3):e12-e13.
Publication Dates
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Publication in this collection
08 Mar 2021 -
Date of issue
2021
History
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Received
03 June 2020 -
Accepted
18 Aug 2020