Meza-Meneses Patricia A, Becerra Rodrigo Pérez, Sainz Gerardo Garza, Ortiz Luis Trujillo, Correa Adrián Martinez, Soriano Alan Rodrigo Pérez, Santiago González Ruben Miguel Angel, Corral Aarón Delgado, Valdez Omar Vieyra, Morales Genaro Argüelles, Díaz Mario Alberto Toledo, Luna Alberto Saldivar, Castro-Fuentes Carlos Alberto, Osornio Sánchez Victor
Infectology Service, Hospital Regional de Alta Especialidad de Ixtapaluca, Servicios de Salud del Instituto Mexicano de Seguro Social Para el Bienestar (IMSS-BIENESTAR), Carretera Federal Mexico-Puebla Km 34.5, Ixtapaluca 56530, Mexico.
Urology Service, Hospital Regional de Alta Especialidad de Ixtapaluca, Servicios de Salud del Instituto Mexicano de Seguro Social Para el Bienestar (IMSS-BIENESTAR), Carretera Federal Mexico-Puebla Km 34.5, Ixtapaluca 56530, Mexico.
Microorganisms. 2025 Apr 30;13(5):1033. doi: 10.3390/microorganisms13051033.
Urinary actinomycosis is a rare condition, often mimicking a urinary tract tumor. Due to its low prevalence, it can be challenging to diagnose and may be mistaken for malignancies. A 33-year-old female patient with a history of type 2 and recurrent urinary tract infections presented to the emergency room with right renal fossa pain radiating to the right hypochondrium, fever with chills, nausea, and vomiting. Physical examination revealed a positive Giordano sign and tenderness at the ipsilateral middle and upper ureteral points. A contrast-enhanced CT scan showed a mass infiltrating the distal third of the right ureter, causing retrograde dilatation and hydronephrosis. Additionally, a liver injury with both liquid and solid components was observed. Therefore, given the suspicion of a urothelial tumor, a diagnostic cystoscopy and ureteroscopy were performed. Using interventional radiology, an abscessed liver lesion was drained, yielding purulent fluid. The histopathological examination revealed no evidence of malignancy. However, due to the strong suspicion of upper urinary tract urothelial carcinoma, a right radical nephroureterectomy with bladder cuff excision and retroperitoneal lymphadenectomy was performed. Histopathological examination ultimately confirmed urinary actinomycosis. Consequently, antibiotic therapy with oral amoxicillin 2 g every 12 h was initiated, leading to a good clinical response. Despite its low incidence, urinary actinomycosis should be considered as a differential diagnosis in cases suspected of urothelial tumors in the upper urinary tract. Increased awareness of this rare condition may help prevent unnecessary surgical interventions.
泌尿生殖系统放线菌病是一种罕见疾病，常表现类似泌尿系统肿瘤。因其发病率低，诊断具有挑战性，可能被误诊为恶性肿瘤。一名33岁患有2型糖尿病且反复发生泌尿系统感染的女性患者因右肾窝疼痛放射至右季肋部、发热伴寒战、恶心及呕吐就诊于急诊室。体格检查发现乔达诺征阳性，同侧输尿管中上段压痛。增强CT扫描显示一个肿块浸润右输尿管远端三分之一，导致逆行性扩张和肾积水。此外，还观察到肝脏有液性和实性成分的损伤。因此，鉴于怀疑为尿路上皮肿瘤，进行了诊断性膀胱镜检查和输尿管镜检查。通过介入放射学方法，对肝脏脓肿病变进行了引流，引出脓性液体。组织病理学检查未发现恶性证据。然而，由于强烈怀疑上尿路尿路上皮癌，遂进行了右根治性肾输尿管切除术，包括膀胱袖口切除和腹膜后淋巴结清扫术。组织病理学检查最终确诊为泌尿生殖系统放线菌病。因此，开始每12小时口服2克阿莫西林进行抗生素治疗，临床反应良好。尽管发病率低，但在怀疑上尿路尿路上皮肿瘤的病例中，应将泌尿生殖系统放线菌病视为鉴别诊断之一。提高对这种罕见疾病的认识可能有助于避免不必要的手术干预。
