Primary Hepatic Actinomycosis

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We present a case of a 60-year-old male with actinomycosis in the liver, which is a rare site to be primarily affected with actinomycosis. Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenic abscesses or neoproliferative processes. So far, about 75 cases of primary hepatic actinomycosis have been reported in the literature. It is usually cryptogenic and is more common among immunocompetent individuals and male subjects. Chart review, review of available literature using medline and relevant bibliographies of published articles. A 60-year-old male presented with complaints of 6 weeks of generalized weakness, anorexia and a 12-pound weight loss. On admission, he had a temperature of 101° F, pallor and mild right upper quadrant tenderness. Past medical history was pertinent for a normal colonoscopy one month ago. Laboratory studies revealed a normocytic normochromic anemia and mild elevations in AST, ALT and alkaline phosphatase. During his hospitalization, he continued to spike daily fevers for over 3 days despite broad-spectrum antibiotics. An Abdominal Ultrasound and CT both suggested a complex mass measuring 10 cm x 8 cm in the right lobe of the liver with mild dilatation of intrahepatic biliary tree. These findings were consistent with an abscess or a tumor. Serum alfafetoprotein was normal. Subsequent CT-guided aspiration biopsy revealed findings of infiltration of neutrophils and characteristic sulfur granules by light microscopy. Actinomyces species was also cultured from aspirated pus. Patient was successfully treated with percutaneous catheter drainage and extended courses of intravenous and oral penicillin treatment. This relatively rare case illustrates the need for high index of suspicion, early diagnosis and appropriate management as the infection can be cured with long tern antibiotic therapy.