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- W3048607789 abstract "A 72-year-old patient presented with a 4-month history of right lower quadrant persistent pain that had worsened three days before presentation. On physical examination, the patient was afebrile with tenderness to palpation in the right lower quadrant without rebound or guarding. No palpable mass was detected. Blood investigations were normal except for an elevated C-reactive protein (CRP 67 mg/l). Contrast-enhanced abdominal CT revealed a thickened-walled, swollen retrocecal appendix with a calcified appendicolith, with infiltration around the mesoappendix and periappendiceal area (Figure 1a). The primary diagnosis of subacute appendicitis was made even though an appendiceal neoplasm could not be eliminated. The patient then underwent an open appendectomy (Figure 1b). The surgical specimen's pathological analysis showed sulfur granules surrounded by neutrophils compatible with appendiceal actinomycosis (Figure 2). The patient was discharged on the second postoperative day with oral antibiotic treatment (Oracilline) for six months.Figure 2Histological examination: Periodic acid-Schiff (PAS) positive colonies of actinomyces in periodontal tissue (PAS, ×100) (a), Sulfur granules showing clusters of filamentous non-spore-forming actinomyces with adjacent neutrophilic infiltrate (hematoxylin-eosin stain, ×20). Inset, the filaments are surrounded by eosinophilic proteinaceous material, which represents a host reaction (hematoxylin-eosin stain, original magnification ×200) (b).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Actinomycosis is a chronic progressive suppurative disease caused by diverse species of Actinomyces, of which Actinomyces israelii and Actinomyces meyeri predominate (Könönen and Wade, 2015Könönen E. Wade W. Actinomyces and related organisms in human infections.Clin Microbiol Rev. 2015; 28: 419-442Crossref PubMed Scopus (158) Google Scholar). It affects mainly the cervical and thoracic regions (Lee et al., 2001Lee I.J. Ha H.K. Park C.M. Kim J.K. Kim J.H. Kim T.K. et al.Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features.Radiology. 2001; 220: 76-80Crossref PubMed Scopus (80) Google Scholar). It rarely involves the abdominopelvic region and represents only 0.02%–0.06% of all etiologies of appendicitis (Choi et al., 2009Choi M.-M. Baek J.H. Beak J.H. Lee J.N. Park S. Lee W.-S. Clinical features of abdominopelvic actinomycosis: report of twenty cases and literature review.Yonsei Med J. 2009; 50: 555-559Crossref PubMed Scopus (52) Google Scholar). As clinical and radiological findings are nonspecific, the accurate diagnosis can only be made on histological examination (Nathaniel et al., 2014Nathaniel N. Grace N. Brian R.D. Donald E.M. Actinomyces appendicitis: diagnostic dilemma–malignancy or infection?.Am Surg. 2014; 80: E33-E35PubMed Google Scholar). In the elderly, actinomycosis is a diagnosis of exclusion, and malignancy should be formally ruled out. None declare. No funding source." @default.
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- W3048607789 date "2020-11-01" @default.
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- W3048607789 title "Actinomycosis: A rare etiology of chronic appendicitis in elderly" @default.
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- W3048607789 doi "https://doi.org/10.1016/j.ijid.2020.08.031" @default.
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