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Actinomycotic liver abscess
T S Al-Khuwaitir1, A A Abdulwahab, T M El-Sharqawy
1Department of Medicine, Riyadh Medical Complex, PO Box 3847, Riyadh, 11481, Kingdom of Saudi Arabia. tsa@naseej.com.sa
Abstract:
Actinomycosis bacteria are known for their disregard to anatomical boundaries and their ability to infect organs all over the body including the liver. Here the infection is usually contained in the form of single or multiple abscesses. The clinical manifestations produced are variable even protean and only in some patients point to the right upper abdominal quadrant. However with appropriate imaging modalities and culture techniques for microaerophilic organisms accurate diagnosis is possible and specific antibiotic therapy can be initiated. We report a patient with an actinomycotic liver abscess and no apparent predisposing factor. She was diagnosed on the basis of a history of fever and right upper quadrant pain and tenderness, the abdominal ultrasound and computed tomography findings of a hypodense liver lesion and a histopathology specimen following a diagnostic and therapeutic aspiration of the liver abscess, and had an excellent response to penicillin therapy which demonstrates the nowadays possible avoidance of laparoscopic, and open surgical intervention for this condition.
Insights
Actinomycosis can cause liver abscesses, often presenting with vague symptoms. Early diagnosis via imaging and cultures, followed by penicillin therapy, can effectively treat liver actinomycosis, avoiding surgery.
Area of Science:
- Microbiology
- Infectious Diseases
- Hepatology
Background:
- Actinomycosis, caused by Actinomyces bacteria, can infect various organs, including the liver, forming abscesses.
- Liver abscesses due to actinomycosis may present with diverse and non-specific clinical manifestations.
- Accurate diagnosis relies on advanced imaging and specific culture techniques for microaerophilic organisms.
Observation:
- A case of actinomycotic liver abscess in a patient without identifiable predisposing factors is presented.
- Diagnosis was established through clinical presentation (fever, right upper quadrant pain), imaging (ultrasound, CT), and histopathology.
- The patient underwent diagnostic and therapeutic aspiration of the liver abscess.
Findings:
- The liver abscess was confirmed to be actinomycotic.
- Histopathology and culture aided in the definitive diagnosis.
- The patient showed an excellent response to specific antibiotic therapy.
Implications:
- This case highlights the importance of considering actinomycosis in liver abscess diagnosis.
- Effective antibiotic treatment, such as penicillin, can resolve actinomycotic liver abscesses.
- Non-surgical management, including antibiotic therapy and aspiration, is a viable alternative to surgical intervention for liver actinomycosis.