Gastric Actinomycosis Case Report and Literature Review

Plamen Chernopolsky,Valentina Madjova,Ivan Krasnaliev,Vasil Bozhkov,Rossen Madjov

doi:10.11648/j.ijg.20210501.11

Abstract

Actinomycosis is an indolent infection that usually presents a diagnostic challenge to the physician. The most commonly affected zones are the cervicofacial, thoracic and abdominal areas. Abdominal actinomycosis although recognized for more than 150 years, is still wide unknown for most of the clinicians. Its various clinical manifestations are usually considered to present malignant process rather than infection. Intramural gastric actinomycosis is extremely rare clinical noosologic unit and usually the original source of infection is unknown. The usual clinical presentations include mild fever, epi- or mesogastric pain, weight loss, and bleeding from upper gastrointestinal tract. This chronic infection has tends to mimic malignancy. Gastric actinomycosis is very rare and with a good prognosis gastric disease. When established clinically, that is quite difficult diagnosis to be done before obtaining a surgical specimen. Although the findings are nonspecific, actinomycosis should be included in the differential diagnosis when CT scans show infiltrative mass with abnormal aggressiveness and dense enhancement of inhomogeneous contrast, especially in patients with leukocytosis, fever, or prolonged use of intrauterine contraceptives. We report a case of intramural gastric actinomycosis and review of cases of abdominal and gastric actinomycosis reported rarely in the literature. Reporting of such clinical case may help clinicians to increase the knowledge and awareness of this rare and treatable disease.

Highlights

Actinomycosis –chronic infectious disease of farm animals and humans due to injury to the mouth with sharp and hard foods infected with the radiant fungus, which exists mainly in cereals - rye, barley, straw, hay
Gastric actinomycosis was diagnosed by the finding of characteristic “sulfur granules” (Figure 3 a, b)
In majority of cases a tentative diagnosis is established by the histological appearance of the sulfur granules, a hallmark of actinomycosis composed of irregular masses of branched Gram-positive filaments with peripheral clubbing

Summary

Introduction

Actinomycosis –chronic infectious disease of farm animals and humans due to injury to the mouth with sharp and hard foods infected with the radiant fungus (actinomycetes), which exists mainly in cereals - rye, barley, straw, hay. Actinomycetes are a group of bacteria found as a natural flora of the oral cavity. Therе аrе four main types of clinical forms of Actinomycosis, to wit - cervicofacial (31-65%), abdominal (20-36%), thoracic (15-30%) and cerebral form. Abdominal actinomycosis was first reported in 1846 by W. Bradshaw [4], (31 years before actinomyces were isolated). Gastric actinomycosis is very rare and with a good prognosis gastric disease. That is quite difficult diagnosis to be done before obtaining a surgical specimen

Case Report

Findings

Discussion

Conclusion