Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, School of Chinese Medicine, China Medical University, Taichung, Taiwan.
J Microbiol Immunol Infect. 2010 Oct;43(5):442-6. doi: 10.1016/S1684-1182(10)60068-0.
Actinomycosis is an uncommon, chronic, granulomatous disease caused by several species of the genus Actinomyces, a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Actinomycosis can be mistaken for malignant tumors, and in most cases the diagnosis is delayed or missed entirely until surgery. Actinomycosis in the abdomen or pelvis mostly results from prolonged use of an intrauterine device. We report the case of a 40-year-old female who presented with decreased urine production, poor appetite, marked loss of body weight and intermittent lower abdominal pain for 3 months. Abdominal computed tomography indicated a large infiltrative pelvic mass that was complicated by bilateral hydronephrosis, bladder compression and small bowel adhesions. Despite the elevated levels of cancer antigen 125, we suspected pelvic actinomycosis because of a 15-year history of an intrauterine device. The diagnosis was confirmed by histopathological examination of soft tissue obtained from a laparotomy biopsy. We successfully treated the patient with prolonged antibiotics instead of surgical eradication. Abdominal computed tomography obtained 1 year later showed almost complete resolution of the pelvic inflammatory mass.
放线菌病是一种罕见的慢性肉芽肿性疾病，由放线菌属的几种细菌引起，这些细菌是革兰阳性、丝状的细菌，通常定植于黏膜区域。放线菌病可能被误诊为恶性肿瘤，在大多数情况下，诊断被延迟或完全遗漏，直到手术。腹部或骨盆中的放线菌病主要是由于宫内节育器的长期使用引起的。我们报告了一例 40 岁女性的病例，她因尿量减少、食欲不振、明显体重减轻和间歇性下腹痛 3 个月就诊。腹部计算机断层扫描提示盆腔有一个大的浸润性肿块，伴有双侧肾盂积水、膀胱压迫和小肠粘连。尽管癌抗原 125 水平升高，我们仍怀疑是盆腔放线菌病，因为她有 15 年的宫内节育器史。通过剖腹手术活检获得的软组织的组织病理学检查证实了这一诊断。我们成功地用长期抗生素治疗了这名患者，而不是手术切除。1 年后获得的腹部计算机断层扫描显示，盆腔炎症性肿块几乎完全消退。
