Images in Clinical Medicine
Actinomyces Hepatic Abscess with Cutaneous Fistula
N Engl J Med 2005; 353:e16November 3, 2005
- Article
A 64-year-old man with a history of colonic resection for adenocarcinoma six years earlier presented with weakness and abdominal discomfort of six months' duration. Computed tomography of the abdomen with administration of contrast material showed multiple hypodense lesions involving the liver. The process on the liver appeared to cross the capsule and peritoneal membrane (arrow, Panel A). There was a small lesion in the upper pole of the spleen. Cultures of a specimen obtained by fine-needle aspiration of a liver lesion showed only Actinomyces israelii (inset). The patient was started on intravenous ampicillin and sulbactam. After eight weeks, a prominent indurated, erythematous swelling developed in his right flank and did not track along the needle-aspiration pathway; the swelling subsequently developed a central draining sinus tract (Panel B). Gram's staining revealed filamentous, beaded gram-positive rods consistent with actinomyces (arrows, Panel A inset). There was no evidence of recurrent cancer on biopsy. The patient has received intravenous antibiotics for seven months, with resolution of the drainage and slow improvement in the size of the liver collections.
Mustafa Saad, M.D.
Jonathan Moorman, M.D., Ph.D.
James H. Quillen Veterans Affairs Medical Center, Johnson City, TN 37614- Citing Articles (3)
Citing Articles
1
Yuki Uehara, Toshimi Takahashi, Michiko Yagoshi, Kazuo Shimoguchi, Mitsuru Yanai, Kazunari Kumasaka, Ken Kikuchi. (2010) Liver Abscess of Actinomyces israelii in a Hemodialysis Patient: Case Report and Review of the Literature. Internal Medicine 49:18, 2017-2020
CrossRef2
Rubén Ciria-Bru, Álvaro Naranjo-Torres, Juan Manuel Sánchez-Hidalgo, Javier Briceño-Delgado, Pedro López-Cillero. (2008) Hepatectomía derecha por actinomicosis hepática. Cirugía Española 83:6, 327-328
CrossRef3
Hidetomo Muto, Tetsuya Ichijo, Noriko Kobayashi, Naoki Tanaka, Takeji Umemura, Michiharu Komatsu, Akihiro Matsumoto, Kaname Yoshizawa, Eiji Tanaka, Kazuhiko Ueda, Masumi Kadoya, Kendo Kiyosawa. (2007) A case of primary hepatic actinomycosis with a presumed invasion to abdominal wall, diagnosed with image examinations by chance. Kanzo 48:11, 553-558
CrossRef
