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[Abdominal actinomycosis after stomach surgery in a patient with long-term rheumatoid arthritis treated with

C Jung1, J Wagner, B Heine

  • 1Abteilung für Allgemeine Innere Medizin, Medizinischen Klinik und Poliklinik.

Deutsche Medizinische Wochenschrift (1946)
|October 16, 1999
PubMed
Abstract

Insights

Actinomycosis, a bacterial infection, can mimic tumors in immunosuppressed patients, particularly after gastrointestinal procedures. Early diagnosis and antibiotic treatment are crucial for recovery.

Area of Science:

  • Medical Microbiology
  • Surgical Pathology
  • Immunocompromised Host Research

Background:

  • Rheumatoid arthritis patients on immunosuppressants (prednisolone, methotrexate) are at risk.
  • Abdominal masses post-gastric surgery require thorough investigation.

Observation:

  • A 78-year-old woman presented with a 3 cm abdominal mass near a Billroth II resection scar.
  • Imaging revealed a superficial, inhomogeneous lesion with ill-defined borders.
  • Reddening of the skin over the mass prompted surgical exploration.

Findings:

  • Laparotomy identified an abscess and inflammatory adhesions, confirmed as actinomycosis.
  • Microscopic examination revealed granular clusters of pathogens characteristic of actinomycosis.
  • The patient had a history of rheumatoid arthritis and recent gastric surgery.

Implications:

  • Actinomycosis should be considered in the differential diagnosis of abdominal masses in immunosuppressed individuals.
  • Invasive gastrointestinal procedures may increase the risk of actinomycosis.
  • Prompt antibiotic therapy (imipenem, doxycycline) led to symptom resolution.

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