Primary perianal actinomycosis over a thirty year period

A 50-year-old Japanese man had had abscesses and draining fistulas in the perianal region. These lesions recurred, despite surgical treatment such as incision and drainage over a 30 year period. "Sulfur granules" were found in the pus from the abscess and Actinomyces israelii was cultured. Ampicillin-cloxacillin treatment lead to healing. The patient died 4 months later with a hepatoma and multiple metastases.