Actinomycosis is endemic worldwide. It has no predilection for age, gender, ethnicity or climate 4.
Predisposing conditions for actinomycosis include 2:
- diabetes mellitus
- previous surgery
- right upper quadrant pain
- nausea and vomiting
- positive Murphy sign
- palpable mass
- biliary colic
- elevated erythrocyte sedimentation rate (ESR)
- elevated serum alkaline phosphatase
- elevated bilirubin
- elevated serum amylase 5
The Actinomyces are a genus of Gram positive anaerobic filamentous bacteria, which may be normally present in the oral cavity, colon, and urogenital tract 4.
Actinomycosis is a chronic suppurative granulomatous infection depicted by the formation of numerous abscesses.
Findings are non-specific and commonly include 1-4:
- gallbladder wall edema
- diffuse mural thickening of gallbladder
- intraluminal mass lesion
Treatment and prognosis
Cholecystectomy with extended antibiotics for as long as one year is advised for patients with all types of actinomycosis to avoid disease recurrence. Therapy of choice is short course high dose IV, followed by oral, penicillin 2,5.
Drainage may also be required if abscesses are present.
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- 2. Fowler RC, Simpkins KC. Abdominal actinomycosis: a report of three cases. (1983) Clinical radiology. 34 (3): 301-7. doi:10.1016/s0009-9260(83)80341-9 - Pubmed
- 3. Amine Elmekkaoui, Amal Bennani, Mehdi Soufi, Mohammed Bouziane, Zahi Ismaili. Actinomycosis of Gallbladder: A Diagnostic Dilemma. (2017) Annals of Clinical Case Reports.
- 4. Acevedo F, Acevedo BR, Acevedo LL, Acevedo GP, Acevedo. Actinomycosis: A Great Pretender. Case Reports of Unusual Presentations and a Review of the Literature. (2008) International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. doi:10.1016/j.ijid.2007.10.006 - Pubmed
- 5. Lee YH, Kim SH, Cho MY, Rhoe BS, Kim MS. Actinomycosis of the gallbladder mimicking carcinoma: a case report with US and CT findings. (2007) Korean journal of radiology. 8 (2): 169-72. doi:10.3348/kjr.2007.8.2.169 - Pubmed