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Published on: April 14, 2026

Actinomycosis Causing Recurrent Perianal Fistulae

Mariana Ferreira Cardoso1, Carla Carneiro2, Luís Carvalho Lourenço1

  • 1Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.

ACG Case Reports Journal
|July 4, 2017
PubMed

Insights

Actinomycosis, a rare but curable infection, should be considered for complex perianal fistulas. Prompt diagnosis and treatment with antibiotics led to significant improvement in a refractory case.

Area of Science:

  • Medical Microbiology
  • Gastroenterology
  • Surgical Infections

Background:

  • Perianal fistulizing disease often presents complex challenges in diagnosis and management.
  • Refractory cases necessitate consideration of uncommon etiologies beyond typical bacterial infections.

Observation:

  • A 26-year-old woman presented with complex perianal fistulae, including trans-sphincteric, suprasphincteric, and rectovaginal tracts.
  • Previous treatments involving abscess drainage, seton placement, and antibiotics yielded minimal improvement.
  • Anal cytology revealed the presence of Actinomyces species.

Findings:

  • Actinomycosis was identified as the underlying cause of the complex perianal fistulae.
  • A treatment regimen of intravenous penicillin followed by oral amoxicillin resulted in remarkable clinical improvement.

Implications:

  • This case highlights the importance of including actinomycosis in the differential diagnosis of refractory perianal fistulizing disease.
  • Early identification and targeted antibiotic therapy can lead to successful outcomes in challenging cases.
  • Considering rare infections is crucial for managing complex anorectal conditions.

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