J Korean Assoc Pediatr Surg.  2015 Jun;21(1):7-10. 10.13029/jkaps.2015.21.1.7.

Periappendiceal Actinomycosis Presenting as Acute Appendicitis

• Kwak JH
• Won EJ
• Choi EH
• Jung SE
• Kim HY

• KMID: 1804835
• DOI: http://doi.org/10.13029/jkaps.2015.21.1.7

Abstract

Abdominal actinomycosis is a rare and chronic progressive disease, especially in children. Clinically, it has non-specific symptoms and diagnostic findings as well as low prevalence, making it very difficult to diagnose prior to intraoperative pathological confirmation. For this reason, abdominal actinomycosis is commonly misdiagnosed as appendicitis. After the histopathological diagnosis of abdominal actinomycosis is made, patients should be administered an appropriate antibiotic such as penicillin. Here we describe a case of appendiceal actinomycosis in an 18-year-old girl who was initially diagnosed with acute appendicitis.

Keyword

Actinomycosis; Appendiceal neoplasms; Appendiceal actinomycosis

MeSH Terms

Actinomycosis*
Adolescent
Appendiceal Neoplasms
Appendicitis*
Child
Diagnosis
Female
Humans
Penicillins
Prevalence
Penicillins

Figure

• 

  Fig. 1 CT image shows a 4.3×2.3 cm mass-like lesion beneath the cecum within the right lower quadrant (arrow). This finding suggested differential diagnosis of advanced appendicitis with phlegmon or a tumorous condition.

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  Fig. 2 Intraoperative findings. (A) Laparoscopic appearance of appendiceal actinomycosis. (B) Gross appearance of appendiceal actinomycosis; a 7.0×4.0 cm appendiceal mass. Severe inflammation and adhesion between the appendix and the adjacent appendiceal serosal surface is visible.

• 

  Fig. 3 (A) Gross appearance of the excised specimen. (B) Pathological examination: Presence of Actinomyces israelii. Acute suppurative appendicitis with a periappendiceal abscess and actinomycotic colonies characterized by sulfur granules (H&E stain, ×40). (C) Pathological examination: Presence of A. israelii. Acute suppurative appendicitis with a periappendiceal abscess and actinomycotic colonies characterized by sulfur granules (H&E stain, ×200).

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