Q J Med 2014; 107:677–678 doi:10.1093/qjmed/hct257 Advance Access Publication 24 December 2013
Clinical picture Computed tomography of an Actinomyces israelii liver abscess A 49-year-old woman with a non-contributory medical history presented with general malaise, poor
Funding External funding was not received for this report. This case originated at the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Figure 1. Computed tomography of the abdomen revealed a huge, heterogeneous, mixed solid and cystic mass occupying nearly the entire right hepatic lobe (size: 15 10 17 cm) with mild enhancement of the solid components. (a) transverse view, (b) coronal view.
Photographs and text from: P.-F. Li and D.-W. Huang, Department of Internal Medicine, TriService General Hospital, National Defense Medical Center, Taipei, Taiwan; C.-K. Peng, Division of Pulmonary and Critical Care Medicine,
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
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appetite, intermittent shortness of breath with activity and mild tenderness in the abdominal right upper quadrant for the past 1 month. Abdominal computed tomography (CT) revealed a huge, heterogeneous, mixed solid and cystic mass occupying nearly the entire right hepatic lobe (size: 15 10 17 cm, Figure 1a and b) with mild enhancement of the solid components. CT findings were consistent with a diagnosis of an actinomycosis liver abscess. Benzylpenicillin (4 mIU i.m. every 4 h) and imipenem/cilastatin (500 mg i.v. every 8 h) were started. Needle aspiration biopsy indicated an Actinomyces israelii liver abscess. After initial treatment was ineffective, an exploratory laparotomy and right lobectomy of the liver were performed; pathology verified A. israelii. Actinomyces liver abscesses are rare and usually caused by A. israelii—a normal flora; most manifestations occur in the cervicofacial area.1,2 If CT imaging reveals a heterogeneous mixed solid and cystic mass in the liver, an actinomycosis liver abscess should be considered as the first diagnosis. Intramuscular injection with benzylpenicillin—the recommended treatment for actinomycosis—can be administered before the results of needle aspiration biopsy are obtained, when the diagnosis is highly suspected based on CT findings.2
678
Clinical picture
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan email: [email protected]
Conflict of interest: None declared.
References 1. Uehara Y, Takahashi T, Yagoshi M, Shimoguchi K, Yanai M, Kumasaka K, et al. Liver abscess of Actinomyces israelii in a hemodialysis patient: case report and review of the literature. Intern Med 2010; 49:2017–20. 2. Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ 2011; 343:d6099.
Downloaded from by guest on November 14, 2015
Clinical picture Computed tomography of an Actinomyces israelii liver abscess A 49-year-old woman with a non-contributory medical history presented with general malaise, poor
Funding External funding was not received for this report. This case originated at the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Figure 1. Computed tomography of the abdomen revealed a huge, heterogeneous, mixed solid and cystic mass occupying nearly the entire right hepatic lobe (size: 15 10 17 cm) with mild enhancement of the solid components. (a) transverse view, (b) coronal view.
Photographs and text from: P.-F. Li and D.-W. Huang, Department of Internal Medicine, TriService General Hospital, National Defense Medical Center, Taipei, Taiwan; C.-K. Peng, Division of Pulmonary and Critical Care Medicine,
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
appetite, intermittent shortness of breath with activity and mild tenderness in the abdominal right upper quadrant for the past 1 month. Abdominal computed tomography (CT) revealed a huge, heterogeneous, mixed solid and cystic mass occupying nearly the entire right hepatic lobe (size: 15 10 17 cm, Figure 1a and b) with mild enhancement of the solid components. CT findings were consistent with a diagnosis of an actinomycosis liver abscess. Benzylpenicillin (4 mIU i.m. every 4 h) and imipenem/cilastatin (500 mg i.v. every 8 h) were started. Needle aspiration biopsy indicated an Actinomyces israelii liver abscess. After initial treatment was ineffective, an exploratory laparotomy and right lobectomy of the liver were performed; pathology verified A. israelii. Actinomyces liver abscesses are rare and usually caused by A. israelii—a normal flora; most manifestations occur in the cervicofacial area.1,2 If CT imaging reveals a heterogeneous mixed solid and cystic mass in the liver, an actinomycosis liver abscess should be considered as the first diagnosis. Intramuscular injection with benzylpenicillin—the recommended treatment for actinomycosis—can be administered before the results of needle aspiration biopsy are obtained, when the diagnosis is highly suspected based on CT findings.2
678
Clinical picture
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan email: [email protected]
Conflict of interest: None declared.
References 1. Uehara Y, Takahashi T, Yagoshi M, Shimoguchi K, Yanai M, Kumasaka K, et al. Liver abscess of Actinomyces israelii in a hemodialysis patient: case report and review of the literature. Intern Med 2010; 49:2017–20. 2. Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ 2011; 343:d6099.
Downloaded from by guest on November 14, 2015
