Abdominal actinomycosis presented as acute abdomen with intra-abdominal multiple tumors: A case report

Actinomycosis, a rare infection caused by Actinomyces spp., typically presents as a chronic condition affecting various regions, particularly the cervicofacial, thoracic, and abdominal areas. Its diagnosis is often difficult due to symptom overlap with malignancies and other infections. This report details a case of abdominal actinomycosis mimicking multiple intra-abdominal tumors, complicating diagnosis and treatment.

A 67-year-old male with uncontrolled type 2 diabetes presented with generalized abdominal pain, nausea, vomiting, constipation, and significant weight loss. Physical examination revealed distention and severe abdominal tenderness. Laboratory tests showed leukocytosis and anemia. Diagnostic laparotomy revealed multiple intra-abdominal tumors. Histopathology confirmed actinomycosis without malignancy or tuberculosis. Intravenous amoxicillin was started; however, the patient discharged himself against medical advice after two days due to personal reasons unrelated to his treatment plan. He returned three months later with persistent abdominal pain and additional hepatic lesions. Extended antibiotic therapy for 12 months led to the resolution of symptoms during follow-up.

Abdominal actinomycosis is rare and often associated with conditions like diabetes. This case underscores the infection's potential to mimic malignancy and highlights the need for considering actinomycosis in differential diagnoses of acute abdomen, especially in immunocompromised patients. The patient's uncontrolled diabetes likely contributed to the infection's development and spread.

Abdominal actinomycosis can present acutely, mimicking neoplastic diseases with multiple intra-abdominal masses. Early recognition and prolonged antibiotic therapy are essential to prevent systemic spread, especially in immunocompromised individuals. Clinicians should consider actinomycosis in patients with poorly controlled diabetes and abdominal symptoms.