Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Abdominal Actinomycosis Mimicking Acute Appendicitis in Children: a Case Report

급성 충수염처럼 보인 복부 방선균증 1예

  • Choi, Sik Kyung (Department of Pediatrics, Hanil General Hospital) ;
  • Bang, Yun Gyu (Department of Pediatrics, Hanil General Hospital) ;
  • Oh, Hyeonsik (Department of Pathology, Hanil General Hospital) ;
  • Lee, Jin (Department of Pediatrics, Hanil General Hospital)
  • 최식경 (한일병원 소아청소년과) ;
  • 방윤규 (한일병원 소아청소년과) ;
  • 오현식 (한일병원 병리과) ;
  • 이진 (한일병원 소아청소년과)
  • Received : 2018.08.22
  • Accepted : 2018.09.27
  • Published : 2018.12.25
Download PDF
⟨ Previous Next ⟩

Abstract

Actinomyces are anaerobic, Gram-positive bacteria that are part of the endogenous flora of mucous membranes in humans. Infection caused by these bacteria is termed actinomycosis. The 3 most common types of actinomycosis are cervicofacial, abdominopelvic, and pulmonary. A previously healthy 6-year-old boy presented with the emergency room with fever, vomiting, and abdominal pain and initially diagnosed with acute appendicitis. Exploratory laparoscopy was done. Histologic finding demonstrated acute gangrenous appendicitis complicated by perforation and sulfur granules compatible with actinomycosis. Subsequently, he was diagnosed with abdominal actinomycosis and received long-term antibiotic therapy. Abdominal actinomycosis is uncommon in children and difficult to diagnose because of its nonspecific symptoms and of difficulties in growing Actinomyces in the clinical setting. It is necessary to include abdominal actinomycosis as a differential diagnosis of children presenting with abdominal pain.

방선균은 피부, 구강, 위장관 및 하부 여성 생식기에 정상균무리로 존재하며 증식속도가 느린 사상체의 형태를 한 혐기 그람 양성균이다. 방선균증은 방선균 감염에 의한 질환으로 대부분 경부 안면 감염증, 복부, 골반 감염증, 그리고 흉부 감염증의 임상 형태로 나타난다. 저자들은 급성 충수염으로 충수절제술을 받은 건강한 6세 남아에서 수술 후 조직검사에서 복부 방선균증을 진단하고 장기간 항생제 치료한 1예를 경험하고 보고하는 바이다. 복부 방선균증은 소아에서는 드문 질환이고 증상이 비특이적이며 균동정을 위한 배양검사가 까다로운 점이 있어 초기 진단이 잘 되지 않고 주로 임상 검체에서 특징적인 조직소견으로 진단되는 경우가 많다. 이를 통해 방선균의 특징을 이해하고 복통을 주소로 내원한 환자에서 정상균무리가 체내로 침입할 수 있는 선행 요인 등을 가진 경우 감별진단에 복부 방선균증도 염두에 두는 것이 바람직하겠다.

Keywords

References

  1. Wacharachaisurapol N, Bender JM, Wang L, Bliss D, Ponrartana S, Pannaraj PS. Abdominal actinomycosis in children: a case report and literature review. Pediatr Infect Dis J 2017;36:e76-9. https://doi.org/10.1097/INF.0000000000001416
  2. Shah HR, Williamson MR, Boyd CM, Balachandran S, Angtuaco TL, McConnell JR. CT findings in abdominal actinomycosis. J Comput Assist Tomogr 1987;11:466-9. https://doi.org/10.1097/00004728-198705000-00018
  3. Sung HY, Lee IS, Kim SI, Jung SE, Kim SW, Kim SY, et al. Clinical features of abdominal actinomycosis: a 15-year experience of a single institute. J Korean Med Sci 2011;26:932-7. https://doi.org/10.3346/jkms.2011.26.7.932
  4. Davies M, Keddie NC. Abdominal actinomycosis. Br J Surg 1973;60:18-22. https://doi.org/10.1002/bjs.1800600104
  5. Karateke F, Ozyazici S, Menekse E, Das K, Ozdogan M. Unusual presentations of actinomycosis; anterior abdominal wall and appendix: report of three cases. Balkan Med J 2013;30:315-7. https://doi.org/10.5152/balkanmedj.2012.377
  6. Sullivan DC, Chapman SW. Bacteria that masquerade as fungi: actinomycosis/nocardia. Proc Am Thorac Soc 2010;7:216-21. https://doi.org/10.1513/pats.200907-077AL
  7. American Academy of Pediatrics. Actinomycosis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red book: 2018 report of the committee on infectious diseases. 31st ed. Itasca: American Academy of Pediatrics, 2018:205-6.
  8. Jacobs RF, Schutze GE. Actinomyces. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier, 2016:1352-4.
  9. Acquaro P, Tagliabue F, Confalonieri G, Faccioli P, Costa M. Abdominal wall actinomycosis simulating a malignant neoplasm: case report and review of the literature. World J Gastrointest Surg 2010;2:247-50.
  10. Benammar S, Helardot PG, Sapin E, Adamsbaum C, Raymond J. Childhood actinomycosis: report of two cases. Eur J Pediatr Surg 1995;5:180-3. https://doi.org/10.1055/s-2008-1066200
  11. Whitworth S, Pence MA, Jacobs RF. Actinomycosis. In: Cherry J, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry's textbook of pediatric infectious diseases. 8th ed. Philadelphia: Elsevier, 2013:1312-6.
  12. Miyamoto MI, Fang FC. Pyogenic liver abscess involving Actinomyces: case report and review. Clin Infect Dis 1993;16:303-9. https://doi.org/10.1093/clind/16.2.303
  13. Kwak JH, Won EJ, Choi EH, Jung SE, Kim HY. Periappendiceal actinomycosis presenting as acute appendicitis. J Korean Assoc Pediatr Surg 2015;21:7-10. https://doi.org/10.13029/jkaps.2015.21.1.7
  14. McGowan JE, Steinberg JP. Other gram-negative bacilli. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's principles and practices of infectious diseases. New York: Churchill Livingstone, 1995:2106-7.
  15. Cato EP, Moore WEC, Nygaard G, Holdeman LV. Actinomyces meyeri sp. nov., specific epithet rev. Int J Syst Bacteriol 1984;34:487-9. https://doi.org/10.1099/00207713-34-4-487
  16. Russo TA. Agents of actinomycosis. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier, 2015:2864-73.
  17. Huang CJ, Huang TJ, Hsieh JS. Pseudo-colonic carcinoma caused by abdominal actinomycosis: report of two cases. Int J Colorectal Dis 2004;19:283-6. https://doi.org/10.1007/s00384-003-0568-y
  18. Abela J, Sciberras J, Meilak M, Felice AG, Degaetano J. Omental actinomycosis presenting with right lower quadrant abdominal pain. J Clin Pathol 2004;57:671.