Actinomyces in Forensic Practice.

Area of Science:

• Medicine
• Infectious Diseases
• Pathology

Background:

• Septic shock and hepatic abscesses are critical conditions requiring prompt diagnosis and treatment.
• Actinomycosis is a rare bacterial infection typically caused by Actinomyces israelii, often presenting with chronic, indolent symptoms.

Observation:

• A 19-year-old woman presented with septic shock and a hepatic abscess, subsequently developing cardiac arrest.
• Surgical exploration revealed a purulent pericardial effusion with tamponade and a liver abscess; initial cultures were negative.
• Autopsy showed pus in the pericardial cavity and liver, with "sulfur granules" extruded from the liver.

Findings:

• Postmortem examination identified Actinomyces israelii as the causative agent of the hepatic abscess.
• The infection led to severe complications including cardiac tamponade and multiorgan failure, ultimately causing death.

Implications:

• This case highlights primary hepatic actinomycosis as a rare but potentially fatal diagnosis.
• The presence of "sulfur granules" at autopsy is a crucial diagnostic clue for Actinomyces infection, even with negative antemortem cultures.
• Nonspecific clinical presentations of hepatic actinomycosis can delay diagnosis, emphasizing the importance of considering this etiology in severe infections.