Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5717
Peer-review started: March 11, 2021
First decision: March 25, 2021
Revised: April 19, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 16, 2021
Processing time: 118 Days and 6.3 Hours
Primary hepatic actinomycosis is a rare infection that can be clinically confused with hepatic pyogenic abscesses or neoproliferative processes. Only a few cases of primary hepatic actinomycosis in children have been reported in the English literature.
We describe a pediatric patient with primary hepatic actinomycosis that involved the base of the right lung and anterior abdominal wall and skin. The patient was diagnosed via histological examination of spontaneously drained material. The patient was successfully treated with an exploratory laparotomy and right posterior segmentectomy of the liver, combined with antibiotic treatment. Following surgery, the patient remains in excellent condition, without evidence of recurrence at the time of drafting this report. To summarize the clinical manifestations, diagnosis, treatment, and outcomes of primary hepatic actinomycosis, 18 case reports in English were reviewed.
We conclude that actinomycosis clinically features a chronic onset, nonspecific symptoms, and a primarily histologic diagnosis. Prolonged antibiotic treatment combined with invasive intervention provides a good prognosis.
Core Tip: Actinomyces are considered natural commensals in the gastrointestinal tract and seldom involved in abdominal infection. We present herein a rare pediatric case of primary hepatic actinomycosis that involved a pulmonary abscess and the anterior abdominal wall and skin. In our case, after diagnosis is made histologically, we chose cefoperazone sulbactam as the main antibiotic treatment which eventually led to a good prognosis when combined with invasive intervention. This case highlights the ultimate importance of early suspect on special infection when normal antibiotic treatment failed and proper antibiotic treatment with surgery are essential in successful treatment for actinomycosis.