[Abdominal actinomycosis simulating Crohn's disease]

Area of Science:

• Infectious Diseases
• Gastroenterology
• Pathology

Background:

• Actinomycosis is a rare, chronic bacterial infection known for causing abscesses and fistulas.
• This condition can present with symptoms that mimic other gastrointestinal disorders, including inflammatory bowel diseases (IBD), diverticulitis, and cancer.
• Accurate and timely diagnosis is often challenging due to its varied and non-specific clinical manifestations.

Observation:

• A case report of a 67-year-old woman with an atypical presentation of actinomycosis is detailed.
• Clinically, the patient's symptoms strongly suggested inflammatory bowel disease.
• Diagnostic procedures including computerized axial tomography, intestinal transit studies, and colonoscopy were performed, yet the initial suspicion remained inflammatory bowel disease.

Findings:

• The definitive diagnosis of actinomycosis was established only after histopathological examination of a surgical specimen.
• This case underscores the significant diagnostic difficulties associated with actinomycosis, particularly in its unusual presentations.
• The study highlights the critical importance of considering actinomycosis in the differential diagnosis of chronic gastrointestinal conditions.

Implications:

• This case emphasizes the need for a high index of suspicion for actinomycosis in patients with chronic, unexplained gastrointestinal symptoms, even when initial investigations suggest other conditions.
• Histopathological analysis remains the gold standard for diagnosing challenging cases of actinomycosis.
• Prolonged antibiotic treatment is essential for successful management and preventing recurrence of actinomycosis.