Actinomycosis complicating sigmoid diverticular disease: a case report

Area of Science:

• Infectious Diseases
• Gastroenterology
• Pathology

Background:

• Actinomycosis is a rare bacterial infection caused by Actinomyces species.
• Sigmoid diverticular disease is a common condition, particularly in older adults.
• Bowel perforation is a serious complication that can lead to systemic infection.

Purpose of the Study:

• To report a unique case of systemic actinomycosis secondary to sigmoid diverticular perforation.
• To highlight the diagnostic challenges and histopathological findings in such cases.
• To emphasize the importance of considering actinomycosis in the differential diagnosis of intra-abdominal infections.

Main Methods:

• Case report of a 63-year-old female patient presenting with severe symptoms.
• Review of laboratory investigations including complete blood count and biochemical tests.
• Analysis of imaging studies such as computerized tomography (CT) scans.
• Post-mortem examination including histopathological analysis of affected tissues.

Main Results:

• Patient presented with hypotension, abdominal tenderness, vaginal discharge, microcytic anemia, hypoalbuminemia, and leukocytosis.
• CT scans revealed small bowel dilatation, sigmoid diverticula, ascites, and pelvic fluid.
• Histopathology confirmed sigmoid diverticular disease with perforation, intense inflammation, and presence of actinomycotic granules in diverticular debris, pelvic abscess, and lung.
• Endometrial biopsy was positive, but vaginal swab was negative for Actinomyces.

Conclusions:

• The clinical course and histomorphological findings strongly suggest perforating sigmoid diverticular actinomycosis as the origin of systemic infection.
• This case underscores the potential for diverticular disease to be a source of disseminated actinomycosis.
• Early recognition and appropriate treatment are crucial for managing this rare but severe condition.