Abdominal actinomycosis presenting as lower gastrointestinal bleeding.

Abstract

Abdominal actinomycosis is difficult to diagnose because of the low index of suspicion, unusual clinical manifestations, and the difficulty in culturing Actinomyces, a normal commensal. The infection often mimics mass lesion and is confused with malignancies, intestinal tuberculosis, ameboma, diverticular disease, and Crohn's disease. The patient descibed here was a 47-year-old man with insulin-requiring diabetes, end-stage renal disease, and hypertension, presenting with symptoms of dizziness, diarrhea, melena, vomiting, and vague right lower quadrant abdominal pain. He was found to be profoundly anemic and multiple ulcers were seen on colonoscopy. He later developed massive gastrointestinal bleeding that required surgical resection of the colon. Macroscopic examination of specimen revealed multiple ulcerations of the cecum and ileocecal valve, associated with fibrotic changes. The diagnosis of actinomycosis was made by histopathological examination of the specimen. Our report describes abdominal actinomycosis causing ileocecal ulceration leading to lower gastrointestinal bleeding. To the best of our knowledge this is the first case presenting as ulceration and bleeding, based on a search of the medical literature in English. Actinomycosis is a rare disease, but given the high cure rate, diagnosis is the key to management. It is important to include actinomycosis in the differential diagnosis for intestinal ulcers and ileocecal bleeds.