Liao Wei-Kai, Huang Shih-Che, Hu Sung-Yuan, Tsai Che-An, Wang Ren-Ching
Department of Emergency Medicine, Taichung Veterans General Hospital.
School of Medicine.
Medicine (Baltimore). 2019 Dec;98(49):e18167. doi: 10.1097/MD.0000000000018167.
Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%).
A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces.
Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules.
A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess.
A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility.
A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.
肾放线菌病是一种罕见的临床感染，由放线菌属细菌引起，呈亚急性至慢性表现。在绝大多数报告病例中诊断为以色列放线菌。腹盆腔表现占所有放线菌病的10%至20%，由于术前正确诊断率较低（<10%），可能被误诊为恶性肿瘤或慢性炎症。
一名38岁酒精性肝硬化男性，出现右侧腰痛、腹痛和发热3天。发现白细胞增多、急性肾损伤和肝功能受损。计算机断层扫描显示多个肾囊性病变，同时右膈下和腹膜后间隙有积液。
通过脓肿和肾切除标本培养出以色列放线菌以及具有硫磺颗粒特征的多发性肾放线菌脓肿的病理结果，确诊为肾放线菌病。
因肾脓肿经皮引流不充分而进行了肾切除术。
在我们的门诊，静脉注射青霉素G（每4小时300万单位）进行了2周的全疗程抗生素治疗，随后口服青霉素V，剂量为每天2克，持续6个月。
原发性肾放线菌病的准确诊断取决于任何组织病理学发现和/或标本培养。高剂量静脉注射青霉素G是首选，其次是口服青霉素V，每种药物的疗程取决于个体情况。
