[Primary hepatic actinomycosis: a clinical case report and review of the literature].

Primitive actinomycotic abscess of the liver is extremely rare: in the world literature are reported twenty cases. The authors report a case of a 73-year-old patient admitted at our hospital in poor general conditions, with twelve kilograms weight loss in the last year, recurrent fever and tenderness in right hypochondrium. CT scan, ultrasonography and angiography showed the presence of a seven-centimeters hypovascularized mass in the fourth segment of the liver. The patient was submitted to surgical segmentectomy of the fourth segment. The histologic examination and the histochemical colorations made on the specimen have given the diagnosis of hepatic actinomycotic abscess. No clinical evidence of other intra-abdominal or extra-abdominal localizations were found. From 1928 to date only twenty similar cases have been reported in the world literature. The mean time between the beginning of the symptoms and the diagnosis was 11.1 months (range: 2-54 months): this to confirm the diagnostic difficulties of the disease. The hepatic lesions are described as single in eight cases and multiple in thirteen. Thirteen patients have been treated only with medical therapy: nine recovered and four died for disease spread. Of the six patients with resectable lesion treated surgically, five recovered and one died for pulmonary recurrence.