[A case of primary hepatic actinomycosis]

Area of Science:

• Medical Microbiology
• Hepatology
• Surgical Pathology

Background:

• Primary hepatic actinomycosis is an uncommon infection, often presenting as a liver mass, necessitating its inclusion in the differential diagnosis of hepatic lesions.
• The case highlights the diagnostic challenges posed by rare infections mimicking malignant tumors in the liver.

Observation:

• A 66-year-old woman presented with right hypochondralgia and a liver tumor identified via ultrasonography and enhanced CT.
• Imaging revealed a 55 mm hypoechoic lesion with specific enhancement patterns, supplied by the right hepatic and inferior phrenic arteries.
• Initial diagnosis was hepatocellular carcinoma with lung invasion, leading to surgical intervention.

Findings:

• Surgical resection of the liver mass and adjacent lung tissue was performed.
• Microscopic examination of the resected specimen definitively diagnosed primary hepatic actinomycosis through the identification of characteristic sulfur granules.

Implications:

• This case underscores the importance of considering actinomycosis in the differential diagnosis of liver masses, even when imaging suggests malignancy.
• Accurate diagnosis through histopathology is crucial for appropriate treatment and patient management, avoiding unnecessary aggressive therapies for benign conditions.