ONLINE ONLY: Abdominal actinomycosis mimicking acute appendicitis

Radiologic techniques are inadequate in the diagnosis of abdominal actinomycosis, except for CT, which shows the site and content of the lesions and their relation to adjacent tissues.2,3 When actinomycosis is suspected, CT-guided aspiration, with or without core biopsy of suspicious lesions, is a useful investigation.3 Surgery is also valuable as a therapeutic adjunct because it enables the débridement of necrotic tissue, the removal of persistent sinuses and a definitive diagnosis. 2 The definitive diagnosis of actinomycosis requires microscopic proof of either the pathogen itself or the presence of specific "sulfur granules."2,3 A combination of long-term antibiotic therapy and adequate surgery is necessary to ensure the complete eradication of actinomycosis because of the large amount of reactive fibrosis formed by the infection.5 However, recent studies have shown that a combination of complete surgical resection followed by short-term antibiotic treatment is effective therapy.4 Penicillin has been shown to be effective in treating abdominal actinomycosis. Other antibiotics used include tetracycline, erythromycin, doxycycline, clindamycin, imipenem, ceftriaxone and ciprofloxacin.1