Hepatic actinomycosis presenting as repeated cholestatic reactions

A patient with hepatic actinomycosis caused by Actinomyces odontolyticus is presented. The clinical course was characterized by 2 yr of episodic abdominal pains and fever together with marked acute elevations of serum alkaline phosphatase. The diagnosis escaped extensive laboratory studies, 2 liver biopsies and 1 laparotomy and was finally verified at a second laparotomy by histology and a positive culture. Histopathology showed multiple small abscesses. No primary focus of infection was found. Treatment with doxycycline was successful.