Renal actinomycosis - a case report

Abstract

Introduction. Actinomycosis of the urogenital tract mainly manifests with formation of renal and perirenal abscesses. When it comes to treating renal lodge abscesses caused by Actinomyces bacteria, the method of choice is mainly surgical evacuation of purulent collections, followed by administration of parenteral penicillin or cephalosporin antibiotics during a six week period. The definitive diagnosis is made based on the antibiogram findings, isolation of Actinomyces israelii from abscess collection, as well as by characteristic histological findings. The exact incidence and prevalence of urogenital actinomycosis is still unknown. Case Report. A 54-year-old female patient was admitted to the Emergency Department of the Clinical Center of Vojvodina for triage. She complained of pain in the left lumbar and gluteal region, weakness, malaise, and fever. She was treated with corticosteroids under the diagnosis of vasculitis five months prior to admission. Based on clinical, laboratory blood and urine tests, ultrasound examination of the abdomen and contrast CT of the abdomen and pelvis, the diagnosis of left kidney abscess was made. It also spread to the retroperitoneum (iliopsoas muscle, gluteus maxuimus and ipsilateral inguinal region). Urgent operative exploration of retroperitoneum and kidney was performed. A lumbotomy was performed in the left half of the retroperitoneum with evacuation of abscesses, as well as partial nephrectomy of the lower half of the left kidney. Subsequently, the obtained antibiogram of operatively sampled aspirate, renal actinomycosis was histopathologically verified. The surgically removed tissue that was sent for histopathology showed presence of connective tissue infiltrated with a pronounced inflammatory infiltrate composed of lymphocytes, plasma cells, histiocytes and granulocytes with numerous microabscesses and actinomycosis colonies.