This document summarizes a case study of a 65-year-old female patient who presented with fever, headache, abdominal discomfort and weight loss for 3 months. Imaging revealed multiple liver lesions and biopsy identified the bacteria Actinomyces israelii. The patient was treated with antibiotics and drainage of liver abscesses, leading to complete resolution of symptoms. Actinomycosis is a rare infection caused by Actinomyces bacteria that can form liver abscesses. Diagnosis requires biopsy and culture, while treatment involves prolonged antibiotics and drainage of affected areas.

1. Case 167
MD Pediatrics
PhD ped study children special need

2. ‫ر‬‫دكتو‬
‫محمد‬ ‫الوهاب‬ ‫عبد‬‫السعدني‬
‫أطفال‬ ‫طب‬ ‫دكتوراه‬‫ـ‬‫الزقازيق‬ ‫طب‬
‫الخاصة‬ ‫االحتياجات‬ ‫ذوى‬ ‫دكتوراه‬‫وتغذيه‬ ‫صحة‬
‫األطفال‬
‫شمس‬ ‫عين‬ ‫طب‬ ‫ـ‬
‫وعالج‬ ‫تشخيص‬ ‫في‬ ‫الدكتوراه‬‫الحميات‬ ‫أمراض‬

3. Name :……
Age; 65 years
Sex: female
Residence: meat Ali
Occupation :house wife
Mariatal state married
Social state High
Diabetic 20 years ago hypertensive 15 years ag
Personal history

4. Complaint
Fever for 3 months not responding to
treatment
Headache , anorexia
…easily tired sweating and occ palpitation
Sense of abdominal discomfort and
fullness……………….

5. Present history
Started 3 months ago by
sudden onset of febrile
illness with generalized
boneache , headache,
sweeting easily tired sense
of abdominal fulness
indigestion and anorexia

6. Fever increased at night with
shivering sweating and
shortness of breath with
palpitation

7. diagnosed as Enterica
Patien asked many Med advices and all
shared diagnosis of Typhoid fever
Treated 10 days with Ciprofloxacin twice
daily with minimal improvement
Of some Symptoms

8. Patint reevaluated
Pyogenic sinsuits by ENT consultant
based on xRay nasal sinuses
Received home medication
Augmentin Two weeks
Minimal improvement of fever and
headache

9. Patient by lab and positive lab
for Malta fever Given
treatment for brucellosis for 8
weeks with no response
Asked medical advice by fever
specialist

10. Refered to hospital with the
above symptoms
No response

12. Through history and
repeated physical
examination revealed

13. General examination
Alert,conscious,active ,non toxic
T 39 c
RR 22/mِ
HR 92/m
,B P 145/95
Chest: BEAE
CVS: S1-S2-O
GIT: soft no visceromegaly
CNS: NAD
L L minimal pertibial edema

14. LAB
Results

15. CBC:
TLC:9.6
RBCs: 3.64
HB: 10
PLAT: 296
ESR: 110
ASO: -VE
CPR: 12 FU
SUGAR :404

16. URINE ANALYSIS
PUS: 5-7
GLUCOSE ++
PROTEIN: ++

17. Widal 1l160
H:-ve
Brucella:-ve
S.creatinine: 1

18. Liver enzymes: normal
ِKideny Function Normal

19. RADIOLOGICAL
STUDY
CXR
ABD U S
ABDOMINIAL COPUTARIZED
CT
ABD MRI

20. Chest x ray : free
Abdominal U/S
Multiple focal lesions for C/T liver

21. CT ABDOMEN:
Mildly enlarged liver with multiple variable
sized marginally enhanced cystic lesions
are seen scattered in both liver lobes
and caudate lobe . the largest measures
about 3.5 cm in diameter and located in
medial segment of the left liver lobe……
signs cobe with multiple liver
granulomas Normal enhancement of the
main portal vein and its two main
branches. No dilated intra-hepatic biliary

23. 19-3-2012
Refered for guided CT liver aspiration
and drainage for Histopathology and
microbiological study

24. BIOPSY under guide CT
Slowly growing
gram +ve
bacteria
: actinomyces
israeli

25. LIVER BIOPSY

26. Monday 23-4-2012
Resolution of all hepatic absceses and
largest one resoled with half cm in
diameter
Pateient will continue ttt at hospital for
further two weeks under tttt
by…………………………………………
……….

28. Abstract
Femal ward 65ys diabetic hypertensive
hepatic actinomycosis Acombination of
surgrgical radiological dranage and
antibiotic proved to lead to complet
cure
‫للجميع‬ ‫شكرا‬

29. discussion
Actinomycosis liver abscess is comonly assoc
with nonspecific clinical and lab signs of infection
Immagine usualy review aspace occuping lesion
suggest either hepatic
tumor or pseeudotumor or inflamatory
Adefinitive diagnosis is histopathology tests on
sample obtained under screen
Adefinitive diagnosis is histopathology tests on
sample obtained under screen
Felekouras et al (92) report hepatic lobectomy in
‫؛‬

30. Felekouras et al (92) report hepatic lobectomy in‫؛‬
case of isolated hepatic actinomycosis(case report)
‫؛‬Ped R health sci J 11:19-21
Samuel 1999 Post g Med j liver acinomycosis as C/o
diverticulosis
liver acinomycosis as liver mass by Vargas 92
medicine 21 111-115
ٍsugano etal in Japan hapatic actinomycosis in japan
case report J gastroentro 9732;;672;6
Ali et al 97 hepatic inv in diss actinomycosis Panc sur 3
;337;9
Bown etal 2011 report acase presenting solely as hapatic
mass co actinomycosis
{

31. Actinomycosis
Actinomyces
Slow growing gram +ve
bacteria , it is a part of
the oral flora in
humans, flamentous
structure gives them
fungal like appearance

32. discussion
case of isolated hepatic actinomycosis(case
report)
‫؛‬Ped R health sci J 11:19-21
Samuel 1999 Post g Med j liver acinomycosis
as C/o diverticulosis
liver acinomycosis as liver mass by Vargas 92
medicine 21 111-115

33. Actinomycosis
IActinomycosis is infection is infection
caused by actinomyces bacteria
Characterized by characteristic
granulomatous suppurative disease
characterized by peripheral spread
with formation of draining sinus affect
cervicofacial,thoracic,abdominal,pelvi

34. Actinomyces in clinical specimen
sputum .crust purulent exudate
surgical nacropsy ,rinsed stain
reveal organisms with classic
silver granules

35. c/s
brain,heart infection agar 37 c
95% nitrogen 5 % co2
incubate aenerobically
organism within 24h
israile filaments spiderlike
growth

36. epidemiology
worldwide without relation to
age ,sex,race,season or
occupation review 85% case
youngest one 28day
etiology human flora
increased in patient with
steroid leukemia renal cong
imm def.HIV

37. pathogenesis
chronic suppurartive scaring
inflammatory process with
dense cellular infiltrate with
suppuration forming many
connecting abscess with sinus
tracts
site
involves,lung.abdomen,orofaci
al

38. c/p
of abdominal and pelvic
after disruption of mucosa of GIT
hepatic affection 15% as solitary or
multiple liver abscesses
chills
fever
night sweets
weight loss
similar to TB

39. diagnosis
microscopic examination with
appropriate stain
c/s of purulent discharge
actinomyces irregular non
spore forming non acid fast
non moblle gram +ve bacillus
c/s aerobic non aerobic

40. abdominal CT
a contrast enhancing
multicystic lesions that can be
approached by CT guided
needle biopsy and C/S

47. Treatment
prolonged antibiotic therapy and
drainaage
Penicillin 250mg/kg/24h q4h
Tetracycilin clendimycin
chloramephenicol injection 2-6
weeks
Oral3-12 months

48. THANK YOU