Diagnostic & Therapeutic Challenges of Actinomycosis: A Benign Speck Masquerading as a Soft Tissue Malignancy Actinomycosis is a chronic infection caused by filamentous gram-positive anaerobes, typically presenting in cervicofacial regions. We report a rare case involving the lower limb of an immunocompetent male, initially suspected to have soft tissue sarcoma based on imaging. The diagnosis was confirmed histologically with characteristic sulfur granules and the Splendore-Hoeppli phenomenon. Despite antibiotic therapy, non-compliancy led to disease progression and necessitated a below-knee amputation. This case emphasises the importance of early diagnosis, patient compliance, and a multidisciplinary approach in managing rare infections mimicking malignancies.
Actinomycosis.

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

Actinomycosis of paranasal sinus is a very rare disease that is caused by infection of Actinomyces species that were present in oral or nasal flora due to trauma or dental treatment. Actinomycosis shows a local calcified lesion associated with soft tissue density on computed tomography, which is similar to fungal sinusitis. Actinomycosis associated with fungal ball due to Aspergillus affecting sinus ventilation has been rarely reported. We experienced two cases of actinomycosis associated with fungal ball and successfully treated with endoscopic sinus surgery and oral antibiotics for 3 months without recurrence.]]>
Actinomyces ; Actinomycosis ; Anti-Bacterial Agents ; Aspergillosis ; Aspergillus ; Paranasal Sinuses ; Rare Diseases ; Recurrence ; Sinusitis ; Ventilation

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

Pelvic actinomycosis is an uncommon infectious disease. It induces a chronic, suppurative illness characterized by an infiltrative and granulomatous response and, thus, the clinical and radiologic findings may mimic other inflammatory and neoplastic conditions. A 56-year-old female with a long-standing intrauterine device was diagnosed with pelvic actinomycosis manifesting as a large uterine mass with locally infiltrative spread into surrounding tissue that mimicked uterine malignancy. Actinomyces israelii infection was confirmed with a surgical specimen, and the patient was treated with antibiotic medication. Pelvic actinomycosis must be included in the differential diagnoses of patients with an infiltrative pelvic mass extending across tissue planes or in patients with findings of multiple microabscesses, particularly in a patient with an intrauterine device, even the lesion primarily involves the uterus.
Actinomyces ; Actinomycosis ; Communicable Diseases ; Diagnosis, Differential ; Female ; Humans ; Intrauterine Devices ; Middle Aged ; Pelvic Inflammatory Disease ; Uterus

Actinomyces are anaerobic, Gram-positive bacteria that are part of the endogenous flora of mucous membranes in humans. Infection caused by these bacteria is termed actinomycosis. The 3 most common types of actinomycosis are cervicofacial, abdominopelvic, and pulmonary. A previously healthy 6-year-old boy presented with the emergency room with fever, vomiting, and abdominal pain and initially diagnosed with acute appendicitis. Exploratory laparoscopy was done. Histologic finding demonstrated acute gangrenous appendicitis complicated by perforation and sulfur granules compatible with actinomycosis. Subsequently, he was diagnosed with abdominal actinomycosis and received long-term antibiotic therapy. Abdominal actinomycosis is uncommon in children and difficult to diagnose because of its nonspecific symptoms and of difficulties in growing Actinomyces in the clinical setting. It is necessary to include abdominal actinomycosis as a differential diagnosis of children presenting with abdominal pain.
Abdomen ; Abdominal Pain ; Actinomyces ; Actinomycosis ; Appendicitis ; Bacteria ; Child ; Diagnosis, Differential ; Emergency Service, Hospital ; Fever ; Gram-Positive Bacteria ; Humans ; Laparoscopy ; Male ; Mucous Membrane ; Sulfur ; Vomiting

PURPOSE: Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001. METHODS: This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris. RESULTS: From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m2). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years. CONCLUSION: Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.
Abscess ; Actinomycosis ; Acute Pain ; Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Male ; Neoplasm Metastasis ; Overweight ; Rectal Fistula ; Recurrence ; Retrospective Studies ; Sulfur ; Suppuration

Facial dimple creation is a simple surgical procedure. Nonetheless, several complications can occur. Actinomycosis is a rare chronic granulomatous infection caused by Actinomyces species. Some conditions that can cause actinomycosis are trauma, oral surgery, and poor dental hygiene. We report a case of actinomycosis that developed on a created facial dimple. A 51-year-old woman presented with a palpable mass on her left cheek that was approximately 1 cm in size. She had undergone facial dimple-creating surgery on both perioral areas at a local clinic 12 years previously. She had not experienced any problems until she was diagnosed with rheumatoid arthritis and diabetes mellitus about 2 years previously, for which she took leflunomide and methotrexate. The mass was completely excised through an intraoral approach. The specimen was grossly described as a gray-yellow cystic mass containing non-absorbable suture material. The filamentous nature of the Actinomyces organisms was observed in dark-stained foci on a histologic examination, confirming the diagnosis of actinomycosis. Indwelling non-absorbable suture materials may increase the risk for opportunistic infections, such as actinomycosis, in immunocompromised patients. Therefore, plastic surgeons should be aware of a patient's general hygiene, immune condition, and medical history when using these materials.
Actinomyces ; Actinomycosis* ; Arthritis, Rheumatoid ; Cheek ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Hygiene ; Immunocompromised Host ; Immunosuppressive Agents ; Methotrexate ; Middle Aged ; Opportunistic Infections ; Oral Hygiene ; Plastics ; Surgeons ; Surgery, Oral ; Sutures

Actinomycosis is a rare chronic suppurative infectious disease caused by Actinomyces spp. Actinomyces are anaerobic Gram-positive bacteria that colonize the mouth, digestive tract, and genital tract. Thoracic actinomycosis is caused by the aspiration of oropharyngeal materials or the spread of cervicofacial infections. Therefore, poor oral hygiene, smoking, and immunodeficiency are risk factors. Actinomycoses are frequently misdiagnosed as anatomical malignancies and thus assessments of the diseases underlying malignancies are often complicated by the presence of actinomycoses. Here, we report a case of mediastinal actinomycosis presenting with clinical and radiological features of metastatic pancreatic cancer. Clinicians should consider the presence of actinomycosis when cancer patients fail to respond to anti-cancer treatments.
Actinomyces ; Actinomycosis* ; Colon ; Communicable Diseases ; Gastrointestinal Tract ; Gram-Positive Bacteria ; Humans ; Lymph Nodes* ; Mouth ; Neoplasm Metastasis* ; Oral Hygiene ; Pancreatic Neoplasms* ; Risk Factors ; Smoke ; Smoking

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.
Actinomyces ; Actinomycosis* ; Adult ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Biopsy, Fine-Needle ; Communicable Diseases ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Fibrosis ; Follow-Up Studies ; Humans ; Male ; Pancreas ; Pancreatitis, Chronic* ; Tail