Abstract
Actinomycosis is a granulomatous disease caused by Actinomyces that mimics other intra-abdominal pathologies especially neoplasms. Correct diagnosis can be rarely established before radical surgery. On the other hand Entamoeba infection affects a considerable number of people worldwide. To our knowledge only one case has been reported to be affected by both organisms. We report a man who has been operated for a mass in the cecum mimicking a perforated colon cancer. Abdominal CT revealed a mass with features of an invading neoplasm. After radical surgery, definitive pathology revealed that the mass was due to actinomycosis associated with Entamoeba infection. The postoperative period was uneventful and the patient was on long-course antibiotherapy. It is important to consider actinomycosis especially in patients with intra-abdominal masses with unusual aggressiveness to prevent unnecessary surgery. However, surgery can be unavoidable especially in the presence of complicated disease or high index of suspicion for malignancy.
Highlights
Actinomyces is an anaerobic, gram-positive saprophytic organism normally present in the gastrointestinal tract, female genital tract, and bronchus [1]
Entamoeba infections are prevalent world-wide and the clinical course may vary from asymptomatic states to “amebomas” which are exophytic, cicatricial, and inflammatory masses due to longstanding and partially treated infections
Actinomycosis is a chronic suppurative disease characterized by the formation of multiple abscesses, draining sinuses, abundant granulation, and dense fibrous tissue [8]
Summary
Actinomyces is an anaerobic, gram-positive saprophytic organism normally present in the gastrointestinal tract, female genital tract, and bronchus [1] It is not always pathologic but it may lead to chronic infectious diseases with destruction of muscular barrier by trauma, endoscopic manipulations, previous operations, gastrointestinal foreign body, and infections like appendicitis [1,2,3]. Entamoeba infections are prevalent world-wide and the clinical course may vary from asymptomatic states to “amebomas” which are exophytic, cicatricial, and inflammatory masses due to longstanding and partially treated infections. These are seen in only 1.5% of patients with amebiasis [5]. The present paper discusses a case of actinomycosis associated with Entamoeba leading to a mass mistaken for perforated colonic carcinoma in a 52-year-old man
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