Ioannidis Orestis, Symeonidis Savvas, Ouzounidis Nikolaos, Foutsitzis Vasilis, Anestiadou Elissavet, Christidis Panagiotis, Loutzidou Lydia, Fesatidou Vasiliki, Kerasidou Ourania, Tsalis Konstantinos, Aggelopoulos Stamatios
4 Academic Department of Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
Med Pharm Rep. 2023 Oct;96(4):441-446. doi: 10.15386/mpr-2073. Epub 2023 Oct 26.
Actinomycosis is an uncommon subacute or chronic suppurative bacterial granulomatous infectious disease with clinical heterogeneity. The majority of actinomycosis cases were of extra-abdominal origin, with oro-cervico-facial cases representing 55%, abdominopelvic representing 20%, and thoracic representing 15% of total reports. Currently, abdominal actinomycosis incidence is approximately 1 case per 119,000 people, being found three times more frequently among males. We report two rare clinical presentations of abdominal actinomycosis affecting the mesentery and the retroperitoneum, respectively.
CASE REPORT 1: A 58-year-old Caucasian male presented to our clinic with abdominal pain in the right upper quadrant. Pre-operative evaluation, although inconclusive, showed a mesocolic mass infiltrating the right and transverse colon. The patient underwent exploratory laparotomy. After partial resection of the mass, the histopathology report demonstrated mesenteric actinomycosis.
CASE REPORT 2: A 40-year-old Caucasian male presented to our clinic complaining about a mucopurulent material from an orifice at the right inguinal region. After appropriate work-up, a large abdominopelvic, stellate mass (75 x 22.8 mm) in the retroperitoneum was revealed. Surgery along with the appropriate antibiotics was used to treat the patient.
Preoperative suspicion and diagnosis of actinomycosis are very challenging, with a high rate of misdiagnosis often resulting in delayed treatment. Our case reports highlight that abdominal actinomycosis should always be part of differential diagnosis, especially when there is involvement of multiple organs. The gold standard treatment of actinomycosis is surgical excision with prolonged antibiotic treatment.
放线菌病是一种罕见的亚急性或慢性化脓性细菌肉芽肿性传染病，具有临床异质性。大多数放线菌病病例起源于腹部以外，口腔颌面部病例占总报告数的55%，腹盆腔病例占20%，胸部病例占15%。目前，腹部放线菌病的发病率约为每119,000人中有1例，男性发病率是女性的三倍。我们报告了两例罕见的腹部放线菌病临床表现，分别累及肠系膜和腹膜后。
病例报告1：一名58岁的白种男性因右上腹疼痛前来我院就诊。术前评估虽未得出明确结论，但显示有一个结肠系膜肿块浸润右结肠和横结肠。患者接受了剖腹探查术。肿块部分切除后，组织病理学报告显示为肠系膜放线菌病。
病例报告2：一名40岁的白种男性前来我院就诊，主诉右腹股沟区有一个孔口流出黏液脓性物质。经过适当检查，发现腹膜后有一个巨大的腹盆腔星状肿块（75×22.8毫米）。采用手术及适当的抗生素对患者进行治疗。
术前对放线菌病的怀疑和诊断极具挑战性，误诊率高，常导致治疗延误。我们的病例报告强调，腹部放线菌病应始终作为鉴别诊断的一部分，尤其是在多个器官受累时。放线菌病的金标准治疗方法是手术切除并延长抗生素治疗时间。
