Hepatic Actinomycotic Abscesses: Diagnosis and Management

Abstract

ctinomycosis is a chronic suppurative and granulomatous disease usually caused by Actinomyces israelii. It is normal flora of the oropharynx, gastrointestinal tract, and female genital tract; inoculation occurs with mucosal disruption. Although most manifest as abscesses in the cervicofacial region, reports of thoracic, abdominal, pelvic, and CNS actinomycosis exist. Intraabdominally, the ileocecal region is most frequently affected. Hepatic involvement has been reported in 15% of those with abdominal disease and represents 5% of all cases of actinomycosis [1]. Gram staining and microscopy can be helpful, with the latter showing pale yellow clusters of tangled filaments surrounded by neutrophils, known as sulfur granules. To culture this bacterium, strict anaerobic processing and semiselective media in the presence of carbon dioxide is required. Without previous suspicion of actinomycosis, cultures are unlikely to elucidate the cause. Treatment consists of penicillin and drainage of the abscesses. We report two cases of hepatic actinomycotic abscesses with contrasting features, one featuring an inferior vena cava (IVC) thrombus (presumed infected) and septic pulmonary emboli.