Unmasking Hepatic Actinomycosis A Rare but Critical Diagnostic Challenge in Abdominal Infections

Introduction

Hepatic Actinomycosis (HA) is a rare but clinically significant form of abdominal actinomycosis that often mimics hepatic malignancies, making early diagnosis challenging. In this case report, a 54-year-old man with a history of chronic pancreatitis presented with severe hepatic involvement, later confirmed as HA. The disease’s subtle clinical signs, along with overlapping imaging features, often delay appropriate treatment.
Visit https://www.anesthesiaresjournal.com/ for more groundbreaking research in clinical anesthesia and critical care infections.

Case Summary and Key Findings

• Patient profile: 54-year-old male with chronic pancreatitis, sacral fistulae, and exocrine pancreatic insufficiency.
• Initial symptoms: Abdominal pain, fever, nausea, and hypotension.
• CT findings: Congestive liver with microabscesses and extensive portal vein thrombosis.
• Microbiology: Blood and hepatic abscess cultures grew Actinomyces turicensis, Eikenella corrodens, and Gemella morbillorum.
• Management: Initiated with broad-spectrum antibiotics and later treated with targeted antibiotics including amoxicillin-clavulanate, along with percutaneous drainage.
• Outcome: Marked clinical improvement; discharged one month post-therapy.
• Read the full study at https://doi.org/10.29328/journal.ijcar.1001019

Clinical and Diagnostic Insight

Hepatic actinomycosis accounts for only 5% of all actinomycosis cases. Its presentation often mimics hepatic tumors, particularly when involving the right liver lobe.

• Common symptoms: Fever, abdominal pain, anorexia
• Diagnostic tools:
  • Histopathology with sulfur granules
  • Culture (often challenging due to prior antibiotic use)
  • Imaging (CT/MRI may suggest malignancy)
  • Advanced modalities like MALDI-TOF and PCR

The American College of Gastroenterology emphasizes the need for thorough microbial investigation in unexplained liver abscesses, especially when initial therapies fail or malignancy is ruled out.

Treatment and Follow-Up

• Antibiotic therapy:
  • Initial IV therapy (4–6 weeks)
  • Followed by oral penicillin derivatives for up to several months
• Drainage: Percutaneous Pigtail catheter insertion significantly aided recovery.
• Monitoring: Follow-up imaging confirmed resolution of lesions.

A detailed analysis can be found in our main journal article.

For more insightful case studies in infectious disease management and anesthesiology, visit https://www.anesthesiaresjournal.com/.

Clinical Takeaway

• Always include hepatic actinomycosis in the differential diagnosis of liver masses.
• Advanced diagnostics and culture techniques are essential for definitive diagnosis.
• Long-term antibiotic therapy with possible surgical or percutaneous drainage improves outcomes.
• Misdiagnosis can lead to unnecessary invasive procedures.

Explore More & Engage

Explore more studies at https://www.anesthesiaresjournal.com/ and join the conversation by sharing your thoughts in the comments below

Disclaimer: This content is generated using AI assistance and should be reviewed for accuracy and compliance before considering this article and its contents as a reference. Any mishaps or grievances raised due to the reusing of this material will not be handled by the author of this article.